Effects of ibuprofen on the physiology and survival of hypothermic sepsis

Objectives: The objective was to compare the clinical and physiologic characteristics of febrile septic patients with hypothermic septic patients; and to examine plasma levels of cytokines tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL 6) and the lipid mediators thromboxane B-2 (TxB(2)) and prostacyclin in hypothermic septic patients in comparison with febrile patients. Most importantly, we wanted to report the effect of ibuprofen treatment on vital signs, organ failure, and mortality in hypothermic sepsis, Setting: The study was performed in the intensive care units (ICUs) of seven clinical centers in the United States and Canada. Patients: Four hundred fifty-five patients admitted to the ICU who met defined criteria for severe sepsis and were suspected of having a serious infection. Intervention: Ibuprofen at a dose of 10 mg/kg (maximum 800 mg) was administered intravenously over 30 to 60 mins every 6 hrs for eight doses vs, placebo (glycine buffer vehicle). Measurements and Main Results: Forty four (10%) septic patients met criteria for hypothermia and 409 were febrile, The mortality rate was significantly higher in hypothermic patients, 70% vs. 35% for febrile patients, At study entry, urinary metabolites of TxB(2) prostacyclin, and serum levels of TNF-alpha and IL 6 were significantly elevated in hypothermic patients compared with febrile patients. In hypothermic patients treated with ibuprofen, there was a trend toward an increased number of days free of major organ system failures and a significant reduction in the 30 day mortality rate from 90% (18/20 placebo treated patients) to 54% (13/24 ibuprofen treated patients). Conclusions: Hypothermic sepsis has an incidence of similar to 10% and an untreated mortality twice that of severe sepsis presenting with fever. When compared with febrile patients, the hypothermic group has an amplified response with respect to cytokines TNF-a and IL 6 and lipid mediators TxB(2) and prostacyclin. Treatment with ibuprofen may decrease mortality in this select group of septic patients.