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

Fever, Lee Byung, Inui Daisuke, Suh Gee, Kim Jae, Kwon Jae, Park Jisook, Tada Keiichi, Tanaka Keiji, Ietsugu Kenichi, Uehara Kenji, Dote Kentaro, Tajimi Kimitaka, Morita Kiyoshi, Matsuo Koichi, Hoshino Koji, Hosokawa Koji, Lee Kook, Lee Kyoung, Takatori Makoto, Nishimura Masaji, Sanui Masamitsu, Ito Masanori, Egi Moritoki, Honda Naofumi, Okayama Naoko, Shime Nobuaki, Tsuruta Ryosuke, Nogami Satoshi, Yoon Seok-Hwa, Fujitani Shigeki, Koh Shin, Takeda Shinhiro, Saito Shinsuke, Hong Sung, Yamamoto Takeshi, Yokoyama Takeshi, Yamaguchi Takuhiro, Nishiyama Tomoki, Igarashi Toshiko, Kakihana Yasuyuki, Koh Younsuck

Description

Fever 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. Methods We 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 (MAX ICU ) and the use of antipyretic treatments with 28-day mortality. Results We recorded body temperature 63,441 times. Antipyretic treatment was given 4,863 .

Sujets

• Thermoregulation
• Antipyretic
• Fever
• Intensive-care medicine
• Mortality

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 9
• Langue: English

Extrait

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* Correspondence: [e-mail] 12 Department of Intensive Care, Okayama University Hospital, Okayama, Japan Full list of author information is available at the end of the article © 2012 FACE study group et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Introduction: Fever 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. Methods: We 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 (MAX ICU ) and the use of antipyretic treatments with 28- day mortality. Results: We 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 (MAX ICU 36.5°C to 37.4°C), MAX ICU ≥ 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). Conclusions: In 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,

Egi et al . Critical Care 2012, 16 :R33 http://ccforum.com/content/16/1/R33