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Meta-Analysis
. 2017 Jan 12;12(1):e0170152.
doi: 10.1371/journal.pone.0170152. eCollection 2017.

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

Zoltan Rumbus  1 , Robert Matics  1 , Peter Hegyi  1   2   3 , Csaba Zsiboras  1 , Imre Szabo  4 , Anita Illes  4 , Erika Petervari  1 , Marta Balasko  1 , Katalin Marta  1   2 , Alexandra Miko  1 , Andrea Parniczky  1   4 , Judit Tenk  1 , Ildiko Rostas  1 , Margit Solymar  1 , Andras Garami  1
Affiliations
Meta-Analysis

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

Zoltan Rumbus et al. PLoS One. .

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%).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study selection and inclusion.
Fig 2
Fig 2. Forest plot analysis of mortality rate using random-effects model in septic patients with fever (body temperature above 38.0°C; n = 6,040).
Fig 3
Fig 3. Forest plot analysis of mortality rate using random-effects model in septic patients with normothermia (body temperature between 36.1 and 38.0°C; n = 3,904).
Fig 4
Fig 4. Forest plot analysis of mortality rate using random-effects model in septic patients with hypothermia (body temperature up to 36.0°C; n = 890).
Fig 5
Fig 5. Meta-regression analysis of the association between body temperature and mortality ratio in septic patients (n = 10, 834).
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References

    1. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med. 2016; 193(3):259–72. Epub 2015/09/29. 10.1164/rccm.201504-0781OC - DOI - PubMed
    1. Esteban A, Frutos-Vivar F, Ferguson ND, Penuelas O, Lorente JA, Gordo F, et al. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med. 2007; 35(5):1284–9. Epub 2007/04/07. 10.1097/01.CCM.0000260960.94300.DE - DOI - PubMed
    1. Vincent JL, Marshall JC, Namendys-Silva SA, Francois B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014; 2(5):380–6. Epub 2014/04/18. 10.1016/S2213-2600(14)70061-X - DOI - PubMed
    1. Walkey AJ, Lagu T, Lindenauer PK. Trends in sepsis and infection sources in the United States. A population-based study. Ann Am Thorac Soc. 2015; 12(2):216–20. Epub 2015/01/09. 10.1513/AnnalsATS.201411-498BC - DOI - PMC - PubMed
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801–10. Epub 2016/02/24. 10.1001/jama.2016.0287 - DOI - PMC - PubMed

Publication types

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).