Clinical

Sepsis patients with hypothermia face greater mortality risk


 

Background: Fevers (like other vital sign abnormalities) often trigger interventions from providers. However, hypothermia (temperature under 36° C) may also be associated with higher mortality.

Study design: Retrospective subanalysis of a previous study (Focused Outcome Research on Emergency Care for Acute respiratory distress syndrome, Sepsis and Trauma [FORECAST]).

Setting: Adult patients with severe sepsis based on Sepsis-2 in 59 ICUs in Japan.

Synopsis: The study involved 1,143 patients admitted to ICUs with severe sepsis (62.6% with septic shock). The median age was 73 years with a median APACHE II and SOFA scores of 22 and 9, respectively. Core temperatures were measured on admission to ICU with patients categorized into three arms: temperature under 36° C (hypothermic), temperature 36°-38° C, and febrile patients with temperature greater than 38° C. Of studied patients, 11.1% were hypothermic on presentation. These patients were older, sicker (higher APACHE/SOFA scores), had lower body mass indexes, and had higher prevalence of septic shock than did the febrile patients. Hypothermic patients fared worse in every clinical outcome measured – in-hospital mortality, 28-day mortality, ventilator-free days, ICU-free days, length of hospital stay, and likelihood of discharge home. The odds ratio of in-hospital mortality for hypothermic patients, compared with reference febrile patients, was 1.76 (95% CI, 1.14-2.73). Patients with hypothermia were also significantly less likely to receive the entire 3-hour resuscitation bundle, including broad-spectrum antibiotics (56.3%) versus 60.8% of patients with temperature 36-38° C and 71.1% for febrile group (P = .003).

Bottom line: Hypothermia in patients with severe sepsis is associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles. More emphasis on earlier identification and treatment of this specific patient population appears needed.

Citation: Kushimoto S et al. Impact of body temperature abnormalities on the implementation of sepsis bundles and outcomes in patients with severe sepsis: A retrospective sub-analysis of the focused outcome of research of emergency care for acute respiratory distress syndrome, sepsis and trauma study. Crit Care Med. 2019 May;47(5):691-9.

Dr. Sekaran is a hospitalist at Massachusetts General Hospital.

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