Multicenter cohort links temperature recovery trajectories, not active rewarming, with outcomes in hypothermic sepsis

In a multicenter retrospective cohort study of 436 patients with sepsis and an admission core temperature below 36 °C, active rewarming was not associated with lower 28-day mortality. Mortality was 45.0% among patients who received active rewarming and 48.0% among those who did not, a nonsignificant difference (P = 0.529). The study was conducted in six intensive care units in China, and the available evidence is limited to the article’s abstract.

Active rewarming was implemented at the discretion of treating clinicians rather than assigned as part of a standardized protocol. The analysis found no association between active rewarming and 90-day mortality, the incidence of acute respiratory distress syndrome or acute kidney injury. Because this was an observational study and rewarming was not randomly assigned, the results do not establish that active rewarming has no effect; they show that receipt of the intervention was not associated with improved outcomes in this cohort.

Group-based trajectory modeling identified four distinct temperature-trajectory phenotypes. Faster restoration of temperature, whether it occurred spontaneously or with active warming, tended to be associated with better survival. By contrast, persistent hypothermia and incomplete rewarming were linked to elevated 28-day mortality risk. The researchers also conducted subgroup and sensitivity analyses, but the abstract does not report the details of those analyses or their results. Overall, the temperature-recovery trajectories appeared more closely associated with prognosis than whether patients received active rewarming.

The findings are bounded by the study’s retrospective, multicenter design and by clinician-directed selection of active rewarming. The supplied abstract also does not describe the distribution of patients among the four trajectory phenotypes, potential confounding factors, or uncertainty for the reported associations. It presents no clinical trial number because the work was not a clinical trial. The authors concluded that prospective studies using standardized rewarming protocols are needed to refine temperature-management strategies for patients with hypothermic sepsis.

Subject of Research: Associations of active rewarming and temperature-recovery trajectories with mortality in hypothermic sepsis

Article Title: Temperature trajectories, active rewarming, and mortality in hypothermic sepsis: a multicenter retrospective cohort study

Article References: Zhang, X., Chen, L., Xu, Y., Chen, F., Sun, R., Xu, Y., Xu, Y., Xu, J., & Chen, H. (2026). Temperature trajectories, active rewarming, and mortality in hypothermic sepsis: a multicenter retrospective cohort study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14505-x

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14505-x

Keywords: hypothermic sepsis, active rewarming, temperature trajectories, 28-day mortality, sepsis, retrospective cohort, intensive care, acute respiratory distress syndrome, acute kidney injury, Temperature, trajectories, active