Hyperthermia is a predictor of high mortality in patients with sepsis
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LETTER
Open Access
Hyperthermia is a predictor of high mortality in patients with sepsis Yanfei Shen1, Yangfang Lou2 and Shiping Zhu2* To the Editor, In a recent study, Shimazui et al. [1] reported that body temperature (BT) on ICU admission exhibited different predictive values in elderly and non-elderly patients with sepsis, and only hypothermia (BT < 36.0 °C) was associated with increased mortality in non-elderly patients while hyperthermia (BT > 38.3 °C) was not. A few issues should be noted. First, the grouping method may underestimate the impact of hyperthermia. In the current study, the whole cohort was divided into the hyperthermia and nonhyperthermia groups, using a cutoff value of BT at 38.3 °C. One limitation is that under this grouping method, both hypothermia and normothermia were classified as non-hyperthermia. Thus, the comparison between the hyperthermia and non-hyperthermia groups could be susceptible to the proportion of patients with hypothermia. For instance, in two hypothetical cohorts (cohort 1: hypothermia n = 80, normothermia n = 20, hyperthermia n = 100 vs. cohort 2: hypothermia n = 20, normothermia n = 80, hyperthermia n = 100), the comparison of mortality between the hyperthermia and non-
hyperthermia groups could be quite different in these two cohorts, as the non-hyperthermia group in cohort 1 (high proportion of hypothermia patients) may have high mortality. In addition, several studies [2] also reported that in sepsis, hyperthermia (Tmax) was also a significant risk for high mortality. Furthermore, one randomized controlled trial (RCT) found that fever control using external cooling to maintain BT between 36.5 and 37.0 °C significantly reduced mortality in septic shock [3]. For validation, we explored the association between BT and mortality in another cohort from MIMIC-III database (Fig. 1). A total of 4201 adult patients with sepsis were included. Consistent with the current study, different associations between BT and mortality were also found in old (≥ 75) and young (< 75) patients. However, in patients with age < 75, both hypothermia and hyperthermia exhibited increased trends of in-hospital mortality (Fig. 1 black bars). Second, the author mentioned that the impact of hypothermia duration on mortality remained unclear. Noteworthy, in a median analysis of previous RCT [3], Schortgen et al. [4] found that 73% of the impact of
* Correspondence: [email protected] 2 Department of Respiratory Medicine, Hangzhou Hospital of Traditional Chinese Medicine, No. 453, Tiyuchang Road, Hangzhou 310000, Zhejiang, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third
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