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