title: Fever Is Associated with Reduced, Hypothermia with Increased Mortality in Septic Patients: A Meta-Analysis of Clinical Trials.
abstract: BACKGROUND
  Sepsis is usually accompanied by changes of body temperature (Tb), but whether fever and hypothermia predict mortality equally or differently is not fully clarified. We aimed to find an association between Tb and mortality in septic patients with meta-analysis of clinical trials.
  
  
  METHODS
  We searched the PubMed, EMBASE, and Cochrane Controlled Trials Registry databases (from inception to February 2016). Human studies reporting Tb and mortality of patients with sepsis were included in the analyses. Average Tb with SEM and mortality rate of septic patient groups were extracted by two authors independently.
  
  
  RESULTS
  Forty-two studies reported Tb and mortality ratios in septic patients (n = 10,834). Pearson correlation analysis revealed weak negative linear correlation (R2 = 0.2794) between Tb and mortality. With forest plot analysis, we found a 22.2% (CI, 19.2-25.5) mortality rate in septic patients with fever (Tb > 38.0°C), which was higher, 31.2% (CI, 25.7-37.3), in normothermic patients, and it was the highest, 47.3% (CI, 38.9-55.7), in hypothermic patients (Tb < 36.0°C). Meta-regression analysis showed strong negative linear correlation between Tb and mortality rate (regression coefficient: -0.4318; P < 0.001). Mean Tb of the patients was higher in the lowest mortality quartile than in the highest: 38.1°C (CI, 37.9-38.4) vs 37.1°C (CI, 36.7-37.4).
  
  
  CONCLUSIONS
  Deep Tb shows negative correlation with the clinical outcome in sepsis. Fever predicts lower, while hypothermia higher mortality rates compared with normal Tb. Septic patients with the lowest (< 25%) chance of mortality have higher Tb than those with the highest chance (> 75%).
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Rumbus
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Robert
authors.initials: R
authors.lastname: Matics
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.|Department of Translational Medicine, First Department of Medicine, University of Pecs, Pecs, Hungary.|Momentum Gastroenterology Multidisciplinary Research Group, Hungarian Academy of Sciences - University of Szeged, Szeged, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Hegyi
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Csaba
authors.initials: C
authors.lastname: Zsiboras
authors.affiliation: Department of Gastroenterology, First Department of Medicine, University of Pecs, Pecs, Hungary.
authors.forename: Imre
authors.initials: I
authors.lastname: Szabo
authors.affiliation: Department of Gastroenterology, First Department of Medicine, University of Pecs, Pecs, Hungary.
authors.forename: Anita
authors.initials: A
authors.lastname: Illes
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Erika
authors.initials: E
authors.lastname: Petervari
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Marta
authors.initials: M
authors.lastname: Balasko
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.|Department of Translational Medicine, First Department of Medicine, University of Pecs, Pecs, Hungary.
authors.forename: Katalin
authors.initials: K
authors.lastname: Marta
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Miko
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.|Department of Gastroenterology, First Department of Medicine, University of Pecs, Pecs, Hungary.
authors.forename: Andrea
authors.initials: A
authors.lastname: Parniczky
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Tenk
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Ildiko
authors.initials: I
authors.lastname: Rostas
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Margit
authors.initials: M
authors.lastname: Solymar
authors.affiliation: Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
authors.forename: Andras
authors.identifier: http://orcid.org/0000-0003-2493-0571
authors.initials: A
authors.lastname: Garami
mesh_terms: D001831:Body Temperature; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D005334:Fever / Q000150:complications*; D006801:Humans; D007035:Hypothermia / Q000150:complications*; D012044:Regression Analysis; D018805:Sepsis / Q000209:etiology / Q000401:mortality* / Q000473:pathology