Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
Authors: 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 ,   the MEDUSA study group, Marx Gernot , Schindler Achim , Schürholz Tobias , Schlegel-Höfner Heike , Lehmann Gunther , Sander Annett , Friese Steffen , Scholz Christian , Fischer Pia , Fuchs Christina , Becher Lutz , Salewsky Norbert , Schreiber Torsten , Goldmann Anton , Keh Didier , Schmid Katrin , Menning Winfried , Steuckart Renate , Barz Robert , Dey Karin , Fahrenholz Meike , Müller Martin , Gerlach Herwig , Toussaint Susanne , Brederlau Jörg , Bach Friedhelm , Buschmann Dirk , Gummelt Ingo , Hoeschen J. , Klaproth Marion , Vedder Ina , Bachmann-Holdau Ulrike , Eiche Jürgen , Hauschild Rolf , Lange Martina , Herrmann-Karbaum Davia , Lubasch Annette , Rücker Marcus , Icke Christian , Lucht Alexander , Meier-Hellmann Andreas , Wagner Jan , Arnold Olaf , Kästner Steffen , Clausen Tobias , Sternkopf Michael , Voswinckel Robert , Benndorf T. , Eiserloh Christel , Kuhnle Gerhard , Koch Mathias , Gerber Manuela , Gründling Matthias , Guderian Liane , Kuhn Sven-Olaf , Scheer Christian , Scheiber Gerd , Bloos Frank , Christink Susann , Kortegast Martina , Matthäus-Krämer Claudia , Mücke Marcel , Poidinger Bernhard , Rüddel Hendrik , Redlich Ulrike , Schwarzkopf Daniel , Thomas-Rüddel Daniel , Volkmer Christel , D’Aria Stefanie , Lemke Thees , Michaelsen Birgit , Schädler Dirk , Schulz-Ruhtenberg Nina , Weiler Norbert , Anetseder Martin , Textor Zoran , Kaisers Udo , Simon Philipp , Braun Georg , Jensen Nicole , Gegenfurtner Werner , Meinhardt Alexander , Schmitt Robert , Teichert Andrea , Becker Klaus-Dieter , Diers Anja , Jelschen Florian , Weyland Andreas , Knebel Frieder , Kupfer Thomas , Sinz Rüdinger , Bautz Petra , Fischer Annemarie , Seibel Armin , Fleischhacker Christoph , Häberle Helene , Henn Philipp , Mezger Friederike , Rosenberger Peter , Riessen Reimer , Ziegler Silvia , Barth Eberhard , Bracht Hendrik , Heymann I. , Hinder A. , Sens R. , Weiss Manfred , Lascho Christof , Micke Henriette , Schmidt Falk , Schilling Stefanie , Wöbker Gabriele 
Published: October 2021

Abstract
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.