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

Introduction

Abnormal body temperatures (T_b) are frequently seen in patients with severe sepsis. However, the relationship between T_b abnormalities and the severity of disease is not clear. This study investigated the impact of T_b 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 T_b at the time of enrollment. The temperature categories (≤35.5°C, 35.6–36.5°C, 36.6–37.5°C, 37.6–38.5°C, 38.6–39.5°C, ≥39.6°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 T_b of ≤36.5°C had significantly worse sequential organ failure assessment (SOFA) scores when compared with patients with T_b >37.5°C on the day of enrollment. Scores for APACHE II were also higher in patients with T_b ≤35.5°C when compared with patients with T_b >36.5°C. The 28-day and hospital mortality was significantly higher in patients with T_b ≤36.5°C. The difference in mortality rate was especially noticeable when patients with T_b ≤35.5°C were compared with patients who had T_b of >36.5°C. Although mortality did not relate to T_b ranges of ≥37.6°C as compared to reference range of 36.6–37.5°C, relative risk for 28-day mortality was significantly greater in patients with 35.6–36.5°C and ≤35.5°C (odds ratio; 2.032, 3.096, respectively). When patients were divided into groups based on the presence (≤36.5°C, n = 160) or absence (>36.5°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 (T_b ≤36.5°C) was associated with increased mortality and organ failure, irrespective of the presence of septic shock.

Trial registration

UMIN-CTR ID UMIN000008195