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. 2015 Mar 30;10(3):e0121919.
doi: 10.1371/journal.pone.0121919. eCollection 2015.

Antipyretic therapy in critically ill patients with sepsis: an interaction with body temperature

Zhongheng Zhang  1 , Lin Chen  1 , Hongying Ni  1
Affiliations

Antipyretic therapy in critically ill patients with sepsis: an interaction with body temperature

Zhongheng Zhang et al. PLoS One. .

Abstract

Background and objective: The effect of antipyretic therapy on mortality in patients with sepsis remains undetermined. The present study aimed to investigate the role of antipyretic therapy in ICU patients with sepsis by using a large clinical database.

Methods: The multiparameter intelligent monitoring in intensive care II (MIMIC- II) database was employed for the study. Adult patients with sepsis were included for analysis. Antipyretic therapy included antipyretic medication and external cooling. Multivariable model with interaction terms were employed to explore the association of antipyretic therapy and mortality risk.

Main results: A total of 15,268 patients fulfilled inclusion criteria and were included in the study. In multivariable model by treating temperature as a continuous variable, there was significant interaction between antipyretic therapy and the maximum temperature (Tmax). While antipyretic therapy had no significant effect on mortality in low temperature quintiles, antipyretic therapy was associated with increased risk of death in the quintile with body temperature >39°C (OR: 1.29, 95% CI: 1.04-1.61).

Conclusion: Our study shows that there is no beneficial effect on reducing mortality risk with the use of antipyretic therapy in ICU patients with sepsis. External cooling may even be harmful in patients with sepsis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Definition of temperature load.
The shaded area indicates normal temperature. The blue non-shaded area is temperature exceeding 37.2°C, termed temperature load.
Fig 2
Fig 2. The relationship between probability of death and Tmax.
The Probability of death increased with increasing Tmax, and the slope was altered by the use of antipyretic therapy.
Fig 3
Fig 3. Probability of death increased with increasing Tmax.
Use of external cooling significantly increased the risk of death, but there was no interaction between external cooling and Tmax.
See this image and copyright information in PMC

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Grants and funding

The study was funded by the science and technology foundation of Jinhua city (approval No. 2013-3-008)(http://www.zjjhst.gov.cn/kjzw/Default.aspx) HN received funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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