Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study

Abstract

IntroductionFever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile etiology. The association of fever and antipyretics with mortality, however, may be different between infective and non-infective illness.MethodsWe designed a prospective observational study to investigate the independent association of fever and the use of antipyretic treatments with mortality in critically ill patients with and without sepsis. We included 1,425 consecutive adult critically ill patients (without neurological injury) requiring > 48 hours intensive care admitted in 25 ICUs. We recorded four-hourly body temperature and all antipyretic treatments until ICU discharge or 28 days after ICU admission, whichever occurred first. For septic and non-septic patients, we separately assessed the association of maximum body temperature during ICU stay (MAXICU) and the use of antipyretic treatments with 28-day mortality.ResultsWe recorded body temperature 63,441 times. Antipyretic treatment was given 4,863 times to 737 patients (51.7%). We found that treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen independently increased 28-day mortality for septic patients (adjusted odds ratio: NSAIDs: 2.61, P = 0.028, acetaminophen: 2.05, P = 0.01), but not for non-septic patients (adjusted odds ratio: NSAIDs: 0.22, P = 0.15, acetaminophen: 0.58, P = 0.63). Application of physical cooling did not associate with mortality in either group. Relative to the reference range (MAXICU 36.5°C to 37.4°C), MAXICU ≥ 39.5°C increased risk of 28-day mortality in septic patients (adjusted odds ratio 8.14, P = 0.01), but not in non-septic patients (adjusted odds ratio 0.47, P = 0.11).ConclusionsIn non-septic patients, high fever (≥ 39.5°C) independently associated with mortality, without association of administration of NSAIDs or acetaminophen with mortality. In contrast, in septic patients, administration of NSAIDs or acetaminophen independently associated with 28-day mortality, without association of fever with mortality. These findings suggest that fever and antipyretics may have different biological or clinical or both implications for patients with and without sepsis.Trial registrationClinicalTrials.gov: NCT00940654

“Oldie But Goodie”: Pediatric Clinical Concepts

“…A prospective observational study by Lee et al of 1,425 consecutive critically ill adult patients (antipyretic treatment was given 4,863 times to 737 patients or 51.7%) reported for septic patients that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen was independently associated with increased mortality and fever was not associated with mortality. 57 For non-septic patients; however, high fever (≥39.5 °C) was independently associated with mortality. 57 A 2017 study by Ye et al reported that the use of antipyretics was associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation and that external cooling was also deleterious.…”

“…57 For non-septic patients; however, high fever (≥39.5 °C) was independently associated with mortality. 57 A 2017 study by Ye et al reported that the use of antipyretics was associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation and that external cooling was also deleterious. 58 …”

Контрольована Нормотермія В Пацієнтів У Критичному Стані З Травматичним Ушкодженням Головного Мозку

“…Это обусловлено тем, что центральная нервная система особенно уязвима при гипертермии, преимущественно длительной или чрезмерной. Только при сепсисе существует вероятность того, что повышение температуры мо-жет обеспечить увеличение уровня выживаемости, однако температура выше 40 °C ассоциирована с ухудшением исходов [5].…”

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(5,33 ± 0,47 балла, p < 0,05) по сравнению с пациентами IV группы (5,66 ± 0,47 балла). При анализе длительности механической вентиляции легких не было выявлено достоверных раз-личий между I (10,86 ± 9,49 суток) и III (10,26 ± 4,13 суток) группами.

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Clinical and investigative critical care medicine in Japan

“…The JSICM has just begun offering (1) a board certification for intensivists within a new governmental program of medical doctor certifications, emulating the European CoBaTrICE program [11], (2) an educational program using parts of multiprofessional critical care review courses, and (3) a clinical trial group to promote multicentre, multinational studies [12]. The modernization of Japanese ICU services is absolutely necessary to (a) satisfy the needs of an aging society over the next few decades [13], (b) adapt the delivery of care to the constant progress of medicine [14], and (c) promote ''evidencebased medicine'' adapted to local clinical settings.…”