Relation between initial hypothermia, course of the hypothermia and mortality in patients with septic shock: a post-hoc analysis of the SEPSISPAM randomized trial.

Background: In patients with septic shock as well as in the critically ill, the impact of hypothermia and core temperature changes during the first 24 h on mortality remains uncertain. In this Methods: This Results: We included 691 patients from the SEPSISPAM trial, of whom 103 (14.9%) presented with hypothermia at inclusion. After adjustment for confounding factors, as compared with patients without hypothermia at inclusion, patients with hypothermia at inclusion had a higher mortality (HR 1.92, 95% CI [1.38-2.67], p < 0.001). Three groups of patients were identified according to the evolution of their core temperature: "without hypothermia" (86.6%), i.e., patients without any hypothermia during the first 24 h; "transient hypothermia" (10%), i.e., patients with hypothermia at inclusion and becoming normothermic during the first 24 h, and "persistent hypothermia" (3.4%), i.e., patients with sustained hypothermia both at inclusion and during the first 24 h. Compared with patients without hypothermia, the "persistent hypothermia" group had the highest mortality rate at day 90 (78.3%, HR 2.83 [1.62-4.95], p < 0.0001). Mortality at day 90 increased according to temperature trajectories, being highest in patients with persistent hypothermia (78%), followed by those with transient hypothermia (49%), and lowest in patients without hypothermia (40%). Conclusion: In patients with septic shock, hypothermia at inclusion and persistence of hypothermia during the first 24 h were associated with higher mortality at day 90. Mortality increased according to the course of hypothermia during the first 24 h, being highest in patients with persistent hypothermia, followed by those with transient hypothermia, and lowest in patients who never developed hypothermia.