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Objectives: To investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients.

Design: Retrospective sub-analysis.

Setting: Fifty-nine ICUs in Japan, from January 2016 to March 2017.

Patients: Adult patients with severe sepsis based on Sepsis-2 were enrolled and divided into three categories (body temperature < 36[degrees]C, 36-38[degrees]C, > 38[degrees]C), using the core body temperature at ICU admission.

Interventions: None.

Measurements and Main Results: Compliance with the bundles proposed in the Surviving Sepsis Campaign Guidelines 2012, in-hospital mortality, disposition after discharge, and the number of ICU and ventilator-free days were evaluated. Of 1,143 enrolled patients, 127, 565, and 451 were categorized as having body temperature less than 36[degrees]C, 36-38[degrees]C, and greater than 38[degrees]C, respectively. Hypothermia-body temperature less than 36[degrees]C-was observed in 11.1% of patients. Patients with hypothermia were significantly older than those with a body temperature of 36-38[degrees]C or greater than 38[degrees]C and had a lower body mass index and higher prevalence of septic shock than those with body temperature greater than 38[degrees]C. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on the day of enrollment were also significantly higher in hypothermia patients. Implementation rates of the entire 3-hour bundle and administration of broad-spectrum antibiotics significantly differed across categories; implementation rates were significantly lower in patients with body temperature less than 36[degrees]C than in those with body temperature greater than 38[degrees]C. Implementation rate of the entire 3-hour resuscitation bundle vasopressor use remeasured lactate significantly differed across categories, as did the in-hospital and 28-day mortality. The odds ratio for in-hospital mortality relative to the reference range of body temperature greater than 38[degrees]C was 1.760 (95% CI, 1.134-2.732) in the group with hypothermia. The proportions of ICU-free and ventilator-free days also significantly differed between categories and were significantly smaller in patients with hypothermia.

Conclusions: Hypothermia was associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles.

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