Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.
Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.
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DOI：
10.1186/cc11211
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发表时间：
2012-02-28
期刊：
影响因子：
--
通讯作者：
Fever and Antipyretic in Critically ill patients Evaluation (FACE) Study Group
中科院分区：
文献类型：
--
作者：
Lee BH;Inui D;Suh GY;Kim JY;Kwon JY;Park J;Tada K;Tanaka K;Ietsugu K;Uehara K;Dote K;Tajimi K;Morita K;Matsuo K;Hoshino K;Hosokawa K;Lee KH;Lee KM;Takatori M;Nishimura M;Sanui M;Ito M;Egi M;Honda N;Okayama N;Shime N;Tsuruta R;Nogami S;Yoon SH;Fujitani S;Koh SO;Takeda S;Saito S;Hong SJ;Yamamoto T;Yokoyama T;Yamaguchi T;Nishiyama T;Igarashi T;Kakihana Y;Koh Y;Fever and Antipyretic in Critically ill patients Evaluation (FACE) Study Group
发烧是经常观察到的危重病人。在具有混合发热病因的非神经系统危重患者中观察到发热与死亡率增加的独立相关性。然而，感染性和非感染性疾病的发热和退热药与死亡率的关系可能不同。我们设计了一项前瞻性观察性研究，以调查发热和使用退热治疗与伴或不伴败血症的危重患者死亡率的独立相关性。我们纳入了1,425名连续的成人重症患者（无神经损伤），这些患者需要在25个ICU中接受> 48小时的重症监护。我们记录了4小时体温和所有退热治疗，直至ICU出院或ICU入院后28天，以先发生者为准。对于脓毒症和非脓毒症患者，我们分别评估了ICU住院期间（MAXICU）的最高体温和使用退热治疗与28天死亡率的相关性。我们记录了63,441次体温。737例（51.7%）患者给予解热治疗4,863次。我们发现非甾体类抗炎药或对乙酰氨基酚单独增加脓毒症患者的28天死亡率（调整后的比值比：NSAID：2.61，P = 0.028，对乙酰氨基酚：2.05，P = 0.01），但非脓毒症患者不存在（校正比值比：NSAID：0.22，P = 0.15，对乙酰氨基酚：0.58，P = 0.63）。物理冷却的应用与两组的死亡率无关。相对于参考范围（MAXICU 36.5 ° C至37.4 ° C），MAXICU ≥ 39.5 ° C会增加脓毒症患者28天死亡率的风险（校正比值比8.14，P = 0.01），但非脓毒症患者不会（校正比值比0.47，P = 0.11）。在非脓毒症患者中，高热（≥ 39.5 ° C）与死亡率独立相关，而NSAID或对乙酰氨基酚给药与死亡率无关。相反，在脓毒症患者中，非甾体抗炎药或对乙酰氨基酚给药与28天死亡率独立相关，而发热与死亡率无关。这些发现表明，发热和解热药可能有不同的生物或临床或两者兼而有之的患者与败血症。ClinicalTrials.gov
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. 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 (MAXICU) and the use of antipyretic treatments with 28-day mortality. 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 (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). 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, 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. ClinicalTrials.gov: NCT00940654
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