Objective: To investigate the effect of body temperature control on organ function and prognosis in patients with refractory septic shock.
Methods: A total of 67 eligible patients with the body temperature over 38.5 °C were enrolled in the study and all patients were treated with a water-flow cooling blanket to control the body temperature below 38.3 °C for 72 hours. The core and peripheral temperature was tested at 1 hour interval. All patients were devised into the following two groups according to their mean core temperature within the 72 hours: the HT group with a mean core temperature ≥ 37.5 °C and the LT group with a mean core temperature <37.5 °C. Hemodynamic, respiratory, and laboratory parameters were tested every 6 hours during the first 72 hours after the temperature increased above 38.5 °C.
Results: Thirty-four patients (50.7%) were classified into the HT group, while thirty-three patients (49.3%) were in the LT group. Compared with the HT group, higher mortality rate at Day 28 was observed in the LT group (69.7% vs 35.3%, P = 0.005). Significant difference in the increase of sepsis-related organ failure assessment (SOFA) score was found between of the HT and the LT groups (1.30 ± 0.90 vs 2.30 ± 2.10, P = 0.02). Statistical differences were observed between the two groups in mean core temperature [(37.90 ± 0.30) °C vs (36.80 ± 0.60) °C, P < 0.000 1], mean peripheral temperature [(37.20 ± 0.30) °C vs (36.30 ± 0.60) °C, P < 0.000 1], minimum core temperature [(36.90 ± 0.30)°C vs (35.80 ± 0.60) °C, P < 0.000 1] and minimum peripheral temperature [(36.20 ± 0.40) °C vs (35.50 ± 0.60) °C, P < 0.000 1], but not in maximum core and peripheral temperature.Statistical difference was also shown in troponin I, fibrinogen, partial thromboplastin and activated partial thromboplastin between the two groups. Cox regression analysis revealed that the mean core temperature was the only independent predictor for the mortality rate at Day 28.
Conclusion: Body temperature control within the normal range may exert potentially detrimental effect on organ function and prognosis in patients with refractory septic shock with fever.