Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

Sheng Ye, Dan Xu, Chenmei Zhang, Mengyao Li, Yanyi Zhang, Sheng Ye, Dan Xu, Chenmei Zhang, Mengyao Li, Yanyi Zhang

Abstract

Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p = 0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p < 0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20-1.66, p < 0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

Conflict of interest statement

The authors declare that they have no competing interests.

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References

    1. McPherson D., Griffiths C., Williams M., et al. Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open. 2013;3(8) doi: 10.1136/bmjopen-2013-002586.e002586
    1. Gotts J. E., Matthay M. A. Sepsis: pathophysiology and clinical management. BMJ (Online) 2016;353 doi: 10.1136/bmj.i1585.i1585
    1. Cavaillon J. Good and bad fever. Critical Care. 2012;16(2, article no. 119) doi: 10.1186/cc11237.
    1. Launey Y., Nesseler N., Mallédant Y., Seguin P. Clinical review: fever in septic ICU patients—friend or foe? Critical Care. 2011;15, article 222 doi: 10.1186/cc10097.
    1. Estudio Nacional de Vigilancia de Infección Nosocomial en UCI (ENVIN-UCI) 2001–2009. 2012
    1. Barie P. S., Hydo L. J., Eachempati S. R. Causes and consequences of fever complicating critical surgical illness. Surgical Infections. 2004;5(2):145–159. doi: 10.1089/sur.2004.5.145.
    1. Edwards J. R., Peterson K. D., Mu Y., et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. American Journal of Infection Control. 2009;37(10):783–805. doi: 10.1016/j.ajic.2009.10.001.
    1. Olaechea P. M., Insausti J., Blanco A., Luque P. Epidemiology and impact of nosocomial infections. Medicina Intensiva. 2010;34(4):256–267. doi: 10.1016/j.medin.2009.11.013.
    1. Beyersmann J., Kneib T., Schumacher M., Gastmeier P. Nosocomial infection, length of stay, and time-dependent bias. Infection Control and Hospital Epidemiology. 2009;30(3):273–276. doi: 10.1086/596020.
    1. Chastre J., Fagon J.-Y. Ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine. 2002;165(7):867–903. doi: 10.1164/ajrccm.165.7.2105078.
    1. Muscedere J. G., Day A., Heyland D. K. Mortality, attributable mortality, and clinical events as end points for clinical trials of ventilator-associated pneumonia and Hospital-acquired pneumonia. Clinical Infectious Diseases. 2010;51(1):S120–S125. doi: 10.1086/653060.
    1. Lambert M.-L., Suetens C., Savey A., et al. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. The Lancet Infectious Diseases. 2011;11(1):30–38. doi: 10.1016/s1473-3099(10)70258-9.
    1. Niven D. J., Stelfox H. T., Laupland K. B. Antipyretic therapy in febrile critically ill adults: a systematic review and meta-analysis. Journal of Critical Care. 2013;28(3):303–310. doi: 10.1016/j.jcrc.2012.09.009.
    1. Zhang Z., Chen L., Ni H. Antipyretic therapy in critically ill patients with sepsis: an interaction with body temperature. PLoS ONE. 2015;10(3) doi: 10.1371/journal.pone.0121919.e0121919
    1. Gall J.-R., Lemeshow S., Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American Multicenter Study. JAMA: The Journal of the American Medical Association. 1993;270(24):2957–2963. doi: 10.1001/jama.1993.03510240069035.
    1. Vincent J.-L., Moreno R., Takala J., et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Medicine. 1996;22(7):707–710. doi: 10.1007/s001340050156.
    1. Vincent J.-L., De Mendonça A., Cantraine F., et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Critical Care Medicine. 1998;26(11):1793–1800. doi: 10.1097/00003246-199811000-00016.
    1. Zhang Z. Univariate description and bivariate statistical inference: the first step delving into data. Annals of Translational Medicine. 2016;4(5, article 91) doi: 10.21037/atm.2016.02.11.
    1. Zhang Z. Model building strategy for logistic regression: purposeful selection. Annals of Translational Medicine. 2016;4(6, article 111) doi: 10.21037/atm.2016.02.15.
    1. Bion J., Jaeschke R., Thompson B. T., Levy M., Dellinger R. P. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Medicine. 2008;34(6):1163–1164. doi: 10.1007/s00134-008-1090-z.
    1. Jain A., Palta S., Saroa R., Palta A., Sama S., Gombar S. Sequential organ failure assessment scoring and prediction of patient's outcome in Intensive Care Unit of a tertiary care hospital. Journal of Anaesthesiology Clinical Pharmacology. 2016;32(3):364–368. doi: 10.4103/0970-9185.168165.
    1. Lee B. H., Inui D., Suh G. Y., et al. Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Critical Care. 2012;16(1, article no. R33) doi: 10.1186/cc11211.

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