RELATIVE ASSOCIATION OF FEVER AND INJURY WITH HYPERMETABOLISM IN CRITICALLY ILL PATIENTS

The purpose of this study was to determine the association of injury t ype (trauma, surgery, medical disease), systemic inflammatory response syndrome (SIRS) and fever with the degree of hypermetabolism in criti cally ill patients. Medical records of 204 critically ill, mechanicall y ventilated injured, surgical and medical patients were reviewed for indirect calorimetry and associated data. Analysis of variance and cov ariance was used to test the effects of injury, fever and SIRS on the degree of hypermetabolism. All injury types were found to be hypermeta bolic. Analysis of variance of hypermetabolism with injury type and pr esence of fever as main effects revealed a significant increase in hyp ermetabolic response from fever, of similar magnitude across all injur y types. Subjects with SIRS were significantly more hypermetabolic tha n subjects without SIRS. However, analysis of variance indicated no ef fect for SIRS but a significant effect for fever in increasing the hyp ermetabolic response. It is concluded that fever portends a magnificat ion of the hypermetabolic response, being similar across injury types. SIRS does not identify hypermetabolic patients independent of fever. The host response to injury, not the injury itself, determines metabol ic rate in critically ill patients. Neither SIRS nor injury type shoul d be used to classify hypermetabolic states without stratifying for pr esence of fever. (C) 1997 Elsevier Science Ltd. All rights reserved.