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Hypothermia in the sepsis syndrome and clinical outcome
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1992
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The study aims to assess the clinical consequences of hypothermia in patients with sepsis syndrome and septic shock. The authors used a multi‑institutional, prospective, randomized, placebo‑controlled design in medical and surgical ICUs, enrolling severe sepsis patients and comparing standard care with or without methylprednisolone. Hypothermia occurred in 9% of patients and was linked to markedly higher rates of CNS dysfunction, liver dysfunction, prolonged clotting times, shock, failure to recover from shock, and death, underscoring a strong adverse prognostic impact that contrasts with protective effects seen in experimental models.
Objective To evaluate the consequences of clinical hypothermia associated with sepsis syndrome and septic shock. Design Analysis of data from a multi-institutional, randomized, placebo-controlled, prospective study with predetermined end-point analysis of development of shock, recovery from shock, hospital length of stay, and death. Setting Multi-institutional medical and surgical ICUs. Patients Patients meeting predetermined criteria for severe sepsis syndrome. Interventions Appropriate sepsis and shock care with 50% of patients receiving methylprednisolone and 50% receiving placebo. Measurements and Main Results The occurrence rate of hypothermia (<35.5°C) is 9% in this population. When compared with febrile patients, hypothermic patients had a higher frequency of central nervous system dysfunction (88% vs. 60%), increased serum bilirubin concentration (35% vs. 15%), prolonged prothrombin times (50% vs. 23%), shock (94% vs. 61%), failure to recover from shock (66% vs. 26%), and death (62% vs. 26%). The hypothermic patients were also more likely to be classified as having a rapidly or ultimately fatal disease upon study admission. Conclusions This prospective study confirms that hypothermia associated with sepsis syndrome has a significant relationship to outcome manifest by increased frequency of shock and death from shock. This finding is in sharp contrast to the protective effects of induced hypothermia in septic animals and perhaps man.