Fever Is Associated with Reduced, Hypothermia with Increased Mortality in Septic Patients: A Meta-Analysis of Clinical Trials

PLoS One. 2017 Jan 12;12(1):e0170152. doi: 10.1371/journal.pone.0170152. eCollection 2017.

Abstract

Background: Sepsis is usually accompanied by changes of body temperature (Tb), but whether fever and hypothermia predict mortality equally or differently is not fully clarified. We aimed to find an association between Tb and mortality in septic patients with meta-analysis of clinical trials.

Methods: We searched the PubMed, EMBASE, and Cochrane Controlled Trials Registry databases (from inception to February 2016). Human studies reporting Tb and mortality of patients with sepsis were included in the analyses. Average Tb with SEM and mortality rate of septic patient groups were extracted by two authors independently.

Results: Forty-two studies reported Tb and mortality ratios in septic patients (n = 10,834). Pearson correlation analysis revealed weak negative linear correlation (R2 = 0.2794) between Tb and mortality. With forest plot analysis, we found a 22.2% (CI, 19.2-25.5) mortality rate in septic patients with fever (Tb > 38.0°C), which was higher, 31.2% (CI, 25.7-37.3), in normothermic patients, and it was the highest, 47.3% (CI, 38.9-55.7), in hypothermic patients (Tb < 36.0°C). Meta-regression analysis showed strong negative linear correlation between Tb and mortality rate (regression coefficient: -0.4318; P < 0.001). Mean Tb of the patients was higher in the lowest mortality quartile than in the highest: 38.1°C (CI, 37.9-38.4) vs 37.1°C (CI, 36.7-37.4).

Conclusions: Deep Tb shows negative correlation with the clinical outcome in sepsis. Fever predicts lower, while hypothermia higher mortality rates compared with normal Tb. Septic patients with the lowest (< 25%) chance of mortality have higher Tb than those with the highest chance (> 75%).

Publication types

  • Meta-Analysis

MeSH terms

  • Body Temperature
  • Clinical Trials as Topic
  • Databases, Factual
  • Fever / complications*
  • Humans
  • Hypothermia / complications*
  • Regression Analysis
  • Sepsis / etiology
  • Sepsis / mortality*
  • Sepsis / pathology

Grants and funding

This research has been supported by the Hungarian Scientific Research Fund (grant PD 105532 to AG), the Medical School, University of Pecs (grant KA-2016-15 to AG), and the New National Excellence Program of the Hungarian Ministry of Human Capacities (UNKP-16-4-III to AG).