PURPOSE: To determine whether fever is associated with an increased or decreased risk of death in patients admitted to an intensive care unit (ICU) with infection. METHODS: We evaluated the independent association between peak temperature in the first 24 h after ICU admission and in-hospital mortality according to whether there was an admission diagnosis of infection using a database of admissions to 129 ICUs in Australia and New Zealand (ANZ) (n = 269,078). Subsequently, we sought to confirm or refute the ANZ database findings using a validation cohort of admissions to 201 ICUs in the UK (n = 366,973). RESULTS: A total of 29,083/269,078 (10.8%) ANZ patients and 103,191/366,973 (28.1%) of UK patients were categorised as having an infection. In the ANZ cohort, adjusted in-hospital mortality risk progressively decreased with increasing peak temperature in patients with infection. Relative to the risk at 36.5-36.9°C, the lowest risk was at 39-39.4°C (adjusted OR 0.56; 95% CI 0.48-0.66). In patients without infection, the adjusted mortality risk progressively increased above 39.0°C (adjusted OR 2.07 at 40.0°C or above; 95% CI 1.68-2.55). In the UK cohort, findings were similar with adjusted odds ratios at corresponding temperatures of 0.77 (95% CI 0.71-0.85) and 1.94 (95% CI 1.60-2.34) for infection and non-infection groups, respectively. CONCLUSIONS: Elevated peak temperature in the first 24 h in ICU is associated with decreased in-hospital mortality in critically ill patients with an infection; randomised trials are needed to determine whether controlling fever increases mortality in such patients.
PURPOSE: To determine whether fever is associated with an increased or decreased risk of death in patients admitted to an intensive care unit (ICU) with infection. METHODS: We evaluated the independent association between peak temperature in the first 24 h after ICU admission and in-hospital mortality according to whether there was an admission diagnosis of infection using a database of admissions to 129 ICUs in Australia and New Zealand (ANZ) (n = 269,078). Subsequently, we sought to confirm or refute the ANZ database findings using a validation cohort of admissions to 201 ICUs in the UK (n = 366,973). RESULTS: A total of 29,083/269,078 (10.8%) ANZpatients and 103,191/366,973 (28.1%) of UK patients were categorised as having an infection. In the ANZ cohort, adjusted in-hospital mortality risk progressively decreased with increasing peak temperature in patients with infection. Relative to the risk at 36.5-36.9°C, the lowest risk was at 39-39.4°C (adjusted OR 0.56; 95% CI 0.48-0.66). In patients without infection, the adjusted mortality risk progressively increased above 39.0°C (adjusted OR 2.07 at 40.0°C or above; 95% CI 1.68-2.55). In the UK cohort, findings were similar with adjusted odds ratios at corresponding temperatures of 0.77 (95% CI 0.71-0.85) and 1.94 (95% CI 1.60-2.34) for infection and non-infection groups, respectively. CONCLUSIONS: Elevated peak temperature in the first 24 h in ICU is associated with decreased in-hospital mortality in critically illpatients with an infection; randomised trials are needed to determine whether controlling fever increases mortality in such patients.
Authors: Carl I Schulman; Nicholas Namias; James Doherty; Ronald J Manning; Pamela Li; Pam Li; Ahmed Elhaddad; Ahmed Alhaddad; David Lasko; Jose Amortegui; Christopher J Dy; Lucie Dlugasch; Gio Baracco; Stephen M Cohn Journal: Surg Infect (Larchmt) Date: 2005 Impact factor: 2.150
Authors: G R Bernard; A P Wheeler; J A Russell; R Schein; W R Summer; K P Steinberg; W J Fulkerson; P E Wright; B W Christman; W D Dupont; S B Higgins; B B Swindell Journal: N Engl J Med Date: 1997-03-27 Impact factor: 91.245
Authors: Paul J Young; Rinaldo Bellomo; Gordon R Bernard; Daniel J Niven; Frederique Schortgen; Manoj Saxena; Richard Beasley; Mark Weatherall Journal: Intensive Care Med Date: 2019-02-11 Impact factor: 17.440
Authors: Thomas Brick; Rachel S Agbeko; Patrick Davies; Peter J Davis; Akash Deep; Peter-Marc Fortune; David P Inwald; Amy Jones; Richard Levin; Kevin P Morris; John Pappachan; Samiran Ray; Shane M Tibby; Lyvonne N Tume; Mark J Peters Journal: Eur J Pediatr Date: 2017-01-18 Impact factor: 3.183
Authors: Paul J Young; Michael J Bailey; Frances Bass; Richard W Beasley; Ross C Freebairn; Naomi E Hammond; Frank M P van Haren; Meg L Harward; Seton J Henderson; Diane M Mackle; Colin J McArthur; Shay P McGuinness; John A Myburgh; Manoj K Saxena; Anne M Turner; Steve A R Webb; Rinaldo Bellomo Journal: Intensive Care Med Date: 2019-10-01 Impact factor: 17.440