Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

Aurélien Culver (1) , Benjamin Coiffard (2) , Francois Antonini (3) , Gary Duclos (3) , Emmanuelle Hammad (3) , Coralie Vigne (3) , Jean-Louis Mege (2) , Karine Baumstarck (4) , Mohamed Boucekine (4) , Laurent Zieleskiewicz (3) , Marc Léone (3, 2)

1 AMU MED - Aix-Marseille Université - Faculté de médecine
2 MEPHI - Microbes évolution phylogénie et infections
3 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
4 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie

Background Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9 °C (p < 0.001) and an amplitude > 0.6 °C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23–0.70], p = 0.001 and HR = 4.73, 95% CI [1.38–16.22], p = 0.01). Conclusions Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.

Mots clés: Critical care; Multiple trauma; Mortality; Body temperature; Circadian rhythm; Mathematical computing

Domaines: Bactériologie; Cardiologie et système cardiovasculaire; Maladies émergentes; Maladies infectieuses; Parasitologie; Virologie

Aurélien Culver, Benjamin Coiffard, Francois Antonini, Gary Duclos, Emmanuelle Hammad, et al.. Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study. Journal of Intensive Care, 2020, 8 (1), ⟨10.1186/s40560-019-0425-x⟩. ⟨hal-02547670⟩