Fever and sepsis - dangerous controversies

Abstract

Introduction. Sepsis is the body?s response to infection, leading to tissue and organ damage. Although fever was considered to be an important sign of sepsis, it has been shown that half of the critically ill patients with sepsis do not have fever at the time of diagnosis. Absence of high body temperature may be a serious disruption of the thermoregulatory response to infection and therefore a reflection of the disease severity. The aim of this study was to determine the percentage of patients with sepsis without fever, and to compare the clinical presentation and outcome of the disease in febrile and afebrile patients. Material and Methods. A retrospective study included 597 patients with sepsis who were divided into two groups: the first included patients with elevated body temperature (? 37.7 ?) and the second included patients who were afebrile (< 37.7 ?). Demographic data, clinical, laboratory and microbiological data, gas analysis parameters, length of hospitalization, and data on the disease outcome were collected and analyzed for all patients. Results. The results show that 41.9% of patients with sepsis did not have fever in the first 24 hours of hospitalization. In the group of afebrile patients, the average age was higher (67.38 ? 14.63 vs. 61.38 ? 18.96 years; p < 0.001) and comorbidities were more common. Patients with elevated body temperature had a significantly lower degree of organ dysfunction measured by the Sequential Organ Failure Assessment score compared to afebrile patients. There were 29.2% of patients with lethal outcome in the group of afebrile patients compared to 18.4% of deceased febrile patients. Conclusion. We conclude that the absence of fever does not rule out the diagnosis of sepsis, but on the contrary, it is associated with greater organ dysfunction and higher mortality, while the elderly are a particularly vulnerable group.