• Shigeki Kushimoto, Toshikazu Abe, Hiroshi Ogura, Atsushi Shiraishi, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Toru Hifumi, Yasukazu Shiino, Taka-Aki Nakada, Takehiko Tarui, Yasuhiro Otomo, Kohji Okamoto, Yutaka Umemura, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin-Ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Kazuma Yamakawa, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Satoshi Gando, and JAAM Focused Outcome Research on Emergency Care for Acute respiratory distress syndrome, Sepsis and Trauma (FORECAST) Group.
• Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
• Crit. Care Med. 2019 May 1; 47 (5): 691-699.

ObjectivesTo investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients.DesignRetrospective sub-analysis.SettingFifty-nine ICUs in Japan, from January 2016 to March 2017.PatientsAdult patients with severe sepsis based on Sepsis-2 were enrolled and divided into three categories (body temperature < 36°C, 36-38°C, > 38°C), using the core body temperature at ICU admission.InterventionsNone.Measurements And Main ResultsCompliance with the bundles proposed in the Surviving Sepsis Campaign Guidelines 2012, in-hospital mortality, disposition after discharge, and the number of ICU and ventilator-free days were evaluated. Of 1,143 enrolled patients, 127, 565, and 451 were categorized as having body temperature less than 36°C, 36-38°C, and greater than 38°C, respectively. Hypothermia-body temperature less than 36°C-was observed in 11.1% of patients. Patients with hypothermia were significantly older than those with a body temperature of 36-38°C or greater than 38°C and had a lower body mass index and higher prevalence of septic shock than those with body temperature greater than 38°C. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on the day of enrollment were also significantly higher in hypothermia patients. Implementation rates of the entire 3-hour bundle and administration of broad-spectrum antibiotics significantly differed across categories; implementation rates were significantly lower in patients with body temperature less than 36°C than in those with body temperature greater than 38°C. Implementation rate of the entire 3-hour resuscitation bundle + vasopressor use + remeasured lactate significantly differed across categories, as did the in-hospital and 28-day mortality. The odds ratio for in-hospital mortality relative to the reference range of body temperature greater than 38°C was 1.760 (95% CI, 1.134-2.732) in the group with hypothermia. The proportions of ICU-free and ventilator-free days also significantly differed between categories and were significantly smaller in patients with hypothermia.ConclusionsHypothermia was associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles.

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