The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis.

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The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis.

Crit Care. 2013 Nov 13;17(6):R271

Authors: Kushimoto S, Gando S, Saitoh D, Mayumi T, Ogura H, Fujishima S, Araki T, Ikeda H, Kotani J, Miki Y, Shiraishi SI, Suzuki K, Suzuki Y, Takeyama N, Takuma K, Tsuruta R, Yamaguchi Y, Yamashita N, Aikawa N

Abstract
INTRODUCTION: Abnormal body temperatures (Tb) are frequently seen in patients with severe sepsis. However, the relationship between Tb abnormalities and the severity of disease is not clear. This study investigated the impact of Tb on disease severity and outcomes in patients with severe sepsis.
METHODS: We enrolled 624 patients with severe sepsis and grouped them into 6 categories according to their Tb at the time of enrollment. The temperature categories (<=35.5[degree sign]C, 35.6--36.5[degree sign]C, 36.6--37.5[degree sign]C, 37.6--38.5[degree sign]C, 38.6--39.5[degree sign]C, >=39.6[degree sign]C) were based on the temperature data of the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring. We compared patient characteristics, physiological data, and mortality between groups.
RESULTS: Patients with Tb of <=36.5[degree sign]C had significantly worse sequential organ failure assessment (SOFA) scores when compared with patients with Tb >37.5[degree sign]C on the day of enrollment. Scores for APACHE II were also higher in patients with Tb <=35.5[degree sign]C when compared with patients with Tb >36.5[degree sign]C. The 28-day and hospital mortality was significantly higher in patients with Tb <=36.5[degree sign]C. The difference in mortality rate was especially noticeable when patients with Tb <=35.5[degree sign]C were compared with patients who had Tb of >36.5[degree sign]C. Although mortality did not relate to Tb ranges of >=37.6[degree sign]C as compared to reference range of 36.6--37.5[degree sign]C, relative risk for 28-day mortality was significantly greater in patients with 35.6--36.5[degree sign]C and <=35.5[degree sign]C (odds ratio; 2.032, 3.096, respectively). When patients were divided into groups based on the presence (<=36.5[degree sign]C, n = 160) or absence (>36.5[degree sign]C, n = 464) of hypothermia, disseminated intravascular coagulation (DIC) as well as SOFA and APACHE II scores were significantly higher in patients with hypothermia. Patients with hypothermia had significantly higher 28-day and hospital mortality rates than those without hypothermia (38.1% vs. 17.9% and 49.4% vs. 22.6%, respectively). The presence of hypothermia was an independent predictor of 28-day mortality, and the differences between patients with and without hypothermia were observed irrespective of the presence of septic shock.
CONCLUSIONS: In patients with severe sepsis, hypothermia (Tb <=36.5[degree sign]C) was associated with increased mortality and organ failure, irrespective of the presence of septic shock.Trial registration: UMIN-CTR ID UMIN000008195.

PMID: 24220071 [PubMed - as supplied by publisher]

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