Hypothermia and cytokines in septic shock. Norasept II Study Investigators. North American study of the safety and efficacy of murine monoclonal antibody to tumor necrosis factor for the treatment of septic shock - PubMed (original) (raw)
Hypothermia and cytokines in septic shock. Norasept II Study Investigators. North American study of the safety and efficacy of murine monoclonal antibody to tumor necrosis factor for the treatment of septic shock
P E Marik et al. Intensive Care Med. 2000 Jun.
Abstract
Background: Hypothermic patients with sepsis have been reported to have a higher mortality than febrile septic patients. The failure to mount a febrile response in sepsis is poorly understood. Since the proinflammatory cytokines play a crucial role in the genesis of fever, we postulated that hypothermic patients with sepsis would have lower circulating levels of these cytokines than febrile patients.
Methods: Patients with septic shock who were enrolled into the placebo limb of the North American study of the safety and efficacy of murine monoclonal antibody to tumor necrosis factor for the treatment of septic shock (NORASEPT II) were analyzed. Body temperature, interleukin-6, tumor necrosis factor alpha, soluble tumor necrosis factor receptor-55, and soluble tumor necrosis factor receptor-75 concentrations were measured at enrollment. The study population was divided into a hypothermic (temperature < 35.6 degrees C) and a febrile group (temperature > or = 38.3 degrees C) according to the core temperature at enrollment (normothermia was an exclusion criteria). Clinical, demographic, and cytokine data were extracted, allowing for comparisons between these two groups of patients. In addition, the correlation between the core body temperature and cytokine levels at enrollment was determined.
Results: A complete data set was available for 930 patients; 195 patients (21%) were hypothermic at enrollment. The 28-day survival of these patients was significantly lower than that of the febrile patients (34% vs. 59%, p < 0.001). Hypothermia (and enrollment temperature) were independent predictors of mortality. The hypothermic patients had a higher incidence of organ dysfunction at enrollment than the febrile patients. There was no significant difference in the cytokine profile between the two groups of patients. In addition, there was no correlation between the core body temperature at enrollment and the circulating levels of cytokines measured.
Conclusion: Hypothermic patients with septic shock have a significantly higher mortality with a higher incidence of organ dysfunction than febrile septic shock patients. The hypothermia in these patients cannot be explained by lower levels of circulating proinflammatory cytokines.
Similar articles
- The effect of aging on circulating levels of proinflammatory cytokines during septic shock. Norasept II Study Investigators.
Marik PE, Zaloga GP; NORASEPT II Study Investigators. North American Sepsis Trial II. Marik PE, et al. J Am Geriatr Soc. 2001 Jan;49(1):5-9. doi: 10.1046/j.1532-5415.2001.49003.x. J Am Geriatr Soc. 2001. PMID: 11207836 Clinical Trial. - Effects of ibuprofen on the physiology and survival of hypothermic sepsis. Ibuprofen in Sepsis Study Group.
Arons MM, Wheeler AP, Bernard GR, Christman BW, Russell JA, Schein R, Summer WR, Steinberg KP, Fulkerson W, Wright P, Dupont WD, Swindell BB. Arons MM, et al. Crit Care Med. 1999 Apr;27(4):699-707. doi: 10.1097/00003246-199904000-00020. Crit Care Med. 1999. PMID: 10321658 Clinical Trial. - The proinflammatory cytokines interleukin-1 and tumor necrosis factor and treatment of the septic shock syndrome.
Dinarello CA. Dinarello CA. J Infect Dis. 1991 Jun;163(6):1177-84. doi: 10.1093/infdis/163.6.1177. J Infect Dis. 1991. PMID: 2037782 Review. - Septic shock.
Klosterhalfen B, Bhardwaj RS. Klosterhalfen B, et al. Gen Pharmacol. 1998 Jul;31(1):25-32. doi: 10.1016/s0306-3623(97)00424-2. Gen Pharmacol. 1998. PMID: 9595273 Review.
Cited by
- Body temperature abnormalities in non-neurological critically ill patients: a review of the literature.
Kushimoto S, Yamanouchi S, Endo T, Sato T, Nomura R, Fujita M, Kudo D, Omura T, Miyagawa N, Sato T. Kushimoto S, et al. J Intensive Care. 2014 Feb 18;2(1):14. doi: 10.1186/2052-0492-2-14. eCollection 2014. J Intensive Care. 2014. PMID: 25520830 Free PMC article. Review. - Hypothermia is Associated With Poor Prognosis in Hospitalized Patients With Severe COVID-19 Symptoms.
Maait Y, El Khoury M, McKinley L, El Khoury A. Maait Y, et al. Cureus. 2021 Apr 16;13(4):e14526. doi: 10.7759/cureus.14526. Cureus. 2021. PMID: 34007774 Free PMC article. - Spontaneous hypothermia on intensive care unit admission is a predictor of unfavorable neurological outcome in patients after resuscitation: an observational cohort study.
den Hartog AW, de Pont AC, Robillard LB, Binnekade JM, Schultz MJ, Horn J. den Hartog AW, et al. Crit Care. 2010;14(3):R121. doi: 10.1186/cc9077. Epub 2010 Jun 23. Crit Care. 2010. PMID: 20573203 Free PMC article. - Intensive fever control using a therapeutic normothermia protocol in patients with febrile early septic shock: A randomized feasibility trial and exploration of the immunomodulatory effects.
Saoraya J, Musikatavorn K, Puttaphaisan P, Komindr A, Srisawat N. Saoraya J, et al. SAGE Open Med. 2020 Jun 3;8:2050312120928732. doi: 10.1177/2050312120928732. eCollection 2020. SAGE Open Med. 2020. PMID: 32547753 Free PMC article. - Clinical indicators for severe prognosis of scrub typhus.
Sriwongpan P, Krittigamas P, Kantipong P, Kunyanone N, Patumanond J, Namwongprom S. Sriwongpan P, et al. Risk Manag Healthc Policy. 2013 Oct 11;6:43-9. doi: 10.2147/RMHP.S52470. eCollection 2013. Risk Manag Healthc Policy. 2013. PMID: 24235852 Free PMC article.
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical