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Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature

BACKGROUND: Fever and hypothermia have been observed in septic patients. Their influence on prognosis is subject to ongoing debates. METHODS: We did a secondary analysis of a large clinical dataset from a quality improvement trial. A binary logistic regression model was calculated to assess the asso...

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Autores principales: Thomas-Rüddel, Daniel O., Hoffmann, Peter, Schwarzkopf, Daniel, Scheer, Christian, Bach, Friedhelm, Komann, Marcus, Gerlach, Herwig, Weiss, Manfred, Lindner, Matthias, Rüddel, Hendrik, Simon, Philipp, Kuhn, Sven-Olaf, Wetzker, Reinhard, Bauer, Michael, Reinhart, Konrad, Bloos, Frank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532310/
https://www.ncbi.nlm.nih.gov/pubmed/34674733
http://dx.doi.org/10.1186/s13054-021-03776-2
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author Thomas-Rüddel, Daniel O.
Hoffmann, Peter
Schwarzkopf, Daniel
Scheer, Christian
Bach, Friedhelm
Komann, Marcus
Gerlach, Herwig
Weiss, Manfred
Lindner, Matthias
Rüddel, Hendrik
Simon, Philipp
Kuhn, Sven-Olaf
Wetzker, Reinhard
Bauer, Michael
Reinhart, Konrad
Bloos, Frank
author_facet Thomas-Rüddel, Daniel O.
Hoffmann, Peter
Schwarzkopf, Daniel
Scheer, Christian
Bach, Friedhelm
Komann, Marcus
Gerlach, Herwig
Weiss, Manfred
Lindner, Matthias
Rüddel, Hendrik
Simon, Philipp
Kuhn, Sven-Olaf
Wetzker, Reinhard
Bauer, Michael
Reinhart, Konrad
Bloos, Frank
author_sort Thomas-Rüddel, Daniel O.
collection PubMed
description BACKGROUND: Fever and hypothermia have been observed in septic patients. Their influence on prognosis is subject to ongoing debates. METHODS: We did a secondary analysis of a large clinical dataset from a quality improvement trial. A binary logistic regression model was calculated to assess the association of the thermal response with outcome and a multinomial regression model to assess factors associated with fever or hypothermia. RESULTS: With 6542 analyzable cases we observed a bimodal temperature response characterized by fever or hypothermia, normothermia was rare. Hypothermia and high fever were both associated with higher lactate values. Hypothermia was associated with higher mortality, but this association was reduced after adjustment for other risk factors. Age, community-acquired sepsis, lower BMI and lower outside temperatures were associated with hypothermia while bacteremia and higher procalcitonin values were associated with high fever. CONCLUSIONS: Septic patients show either a hypothermic or a fever response. Whether hypothermia is a maladaptive response, as indicated by the higher mortality in hypothermic patients, or an adaptive response in patients with limited metabolic reserves under colder environmental conditions, remains an open question. Trial registration The original trial whose dataset was analyzed was registered at ClinicalTrials.gov (NCT01187134) on August 23, 2010, the first patient was included on July 1, 2011. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03776-2.
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spelling pubmed-85323102021-10-25 Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature Thomas-Rüddel, Daniel O. Hoffmann, Peter Schwarzkopf, Daniel Scheer, Christian Bach, Friedhelm Komann, Marcus Gerlach, Herwig Weiss, Manfred Lindner, Matthias Rüddel, Hendrik Simon, Philipp Kuhn, Sven-Olaf Wetzker, Reinhard Bauer, Michael Reinhart, Konrad Bloos, Frank Crit Care Research BACKGROUND: Fever and hypothermia have been observed in septic patients. Their influence on prognosis is subject to ongoing debates. METHODS: We did a secondary analysis of a large clinical dataset from a quality improvement trial. A binary logistic regression model was calculated to assess the association of the thermal response with outcome and a multinomial regression model to assess factors associated with fever or hypothermia. RESULTS: With 6542 analyzable cases we observed a bimodal temperature response characterized by fever or hypothermia, normothermia was rare. Hypothermia and high fever were both associated with higher lactate values. Hypothermia was associated with higher mortality, but this association was reduced after adjustment for other risk factors. Age, community-acquired sepsis, lower BMI and lower outside temperatures were associated with hypothermia while bacteremia and higher procalcitonin values were associated with high fever. CONCLUSIONS: Septic patients show either a hypothermic or a fever response. Whether hypothermia is a maladaptive response, as indicated by the higher mortality in hypothermic patients, or an adaptive response in patients with limited metabolic reserves under colder environmental conditions, remains an open question. Trial registration The original trial whose dataset was analyzed was registered at ClinicalTrials.gov (NCT01187134) on August 23, 2010, the first patient was included on July 1, 2011. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03776-2. BioMed Central 2021-10-21 /pmc/articles/PMC8532310/ /pubmed/34674733 http://dx.doi.org/10.1186/s13054-021-03776-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Thomas-Rüddel, Daniel O.
Hoffmann, Peter
Schwarzkopf, Daniel
Scheer, Christian
Bach, Friedhelm
Komann, Marcus
Gerlach, Herwig
Weiss, Manfred
Lindner, Matthias
Rüddel, Hendrik
Simon, Philipp
Kuhn, Sven-Olaf
Wetzker, Reinhard
Bauer, Michael
Reinhart, Konrad
Bloos, Frank
Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
title Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
title_full Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
title_fullStr Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
title_full_unstemmed Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
title_short Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
title_sort fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532310/
https://www.ncbi.nlm.nih.gov/pubmed/34674733
http://dx.doi.org/10.1186/s13054-021-03776-2
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