TY - JOUR
T1 - The Association of Fever and Antipyretic Medication with Outcomes in Mechanically Ventilated Patients
T2 - A Cohort Study
AU - Evans, Emily M.
AU - Doctor, Rebecca J.
AU - Gage, Brian F.
AU - Hotchkiss, Richard S.
AU - Fuller, Brian M.
AU - Drewry, Anne M.
N1 - Funding Information:
EE was supported by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under Award Number TL1 TR002344. AD and BF were supported by the Washington University Institute of Clinical and Translational Sciences grant KL2 TR000450. EE, AD, BF, and BG were supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. RH reports he received study funding from RevImmune (Accentia Bio-pharmaceuticals, Inc., Tampa, FL) and grants from the National Institutes of Health. EE, RD, BG, BF, and AD declare they have no conflicts of interest.
Publisher Copyright:
© 2019 by the Shock Society.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background:Fever is common in mechanically ventilated patients and may be uniquely detrimental in those with lung injury because of its injurious effects on pulmonary vascular permeability and alveolar epithelium. We evaluated the association of fever and antipyretic medication with mortality in mechanically ventilated emergency department (ED) patients.Methods:This is a retrospective cohort study of 1,264 patients requiring mechanical ventilation initiated in the ED with subsequent admission to an intensive care unit. Maximum body temperature was recorded for the first 24h after ED admission and categorized into four categories: <37°C, 37°C to 38.2°C, 38.3°C to 39.4°C, and ≥39.5°C. The primary outcome was 28-day mortality. We conducted a planned subgroup analysis of patients with sepsis at the time of intubation. Multivariable Cox proportional hazard ratios (HRs) were used to assess the relationship between temperature, antipyretics, and mortality.Results:Multivariable Cox proportional HRs demonstrated that a maximum temperature ≥39.5°C was associated with increased mortality (adjusted hazard ratio [aHR] 1.59 [95% confidence interval, CI, 1.05-2.39]). In the subgroup of patients with sepsis, a maximum temperature of 38.3°C to 39.4°C was associated with survival (aHR 0.61 [95% CI, 0.39-0.99]). There was no difference in 28-day mortality between patients who did and did not receive antipyretic medication in either the overall cohort or the septic subgroup.Conclusion:High fever (≥39.5°C) was associated with increased risk for mortality in mechanically ventilated patients. However, in patients with sepsis, moderate fever (38.3°C-39.4°C) was protective. Antipyretic medication was not associated with changes in outcome. This suggests that fever may have different implications in septic versus nonseptic mechanically ventilated patients.
AB - Background:Fever is common in mechanically ventilated patients and may be uniquely detrimental in those with lung injury because of its injurious effects on pulmonary vascular permeability and alveolar epithelium. We evaluated the association of fever and antipyretic medication with mortality in mechanically ventilated emergency department (ED) patients.Methods:This is a retrospective cohort study of 1,264 patients requiring mechanical ventilation initiated in the ED with subsequent admission to an intensive care unit. Maximum body temperature was recorded for the first 24h after ED admission and categorized into four categories: <37°C, 37°C to 38.2°C, 38.3°C to 39.4°C, and ≥39.5°C. The primary outcome was 28-day mortality. We conducted a planned subgroup analysis of patients with sepsis at the time of intubation. Multivariable Cox proportional hazard ratios (HRs) were used to assess the relationship between temperature, antipyretics, and mortality.Results:Multivariable Cox proportional HRs demonstrated that a maximum temperature ≥39.5°C was associated with increased mortality (adjusted hazard ratio [aHR] 1.59 [95% confidence interval, CI, 1.05-2.39]). In the subgroup of patients with sepsis, a maximum temperature of 38.3°C to 39.4°C was associated with survival (aHR 0.61 [95% CI, 0.39-0.99]). There was no difference in 28-day mortality between patients who did and did not receive antipyretic medication in either the overall cohort or the septic subgroup.Conclusion:High fever (≥39.5°C) was associated with increased risk for mortality in mechanically ventilated patients. However, in patients with sepsis, moderate fever (38.3°C-39.4°C) was protective. Antipyretic medication was not associated with changes in outcome. This suggests that fever may have different implications in septic versus nonseptic mechanically ventilated patients.
KW - Acute respiratory distress syndrome
KW - antipyretics
KW - fever
KW - mechanical ventilation
KW - mortality
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85069948258&partnerID=8YFLogxK
U2 - 10.1097/SHK.0000000000001368
DO - 10.1097/SHK.0000000000001368
M3 - Article
C2 - 31058720
AN - SCOPUS:85069948258
SN - 1073-2322
VL - 52
SP - 152
EP - 159
JO - Shock
JF - Shock
IS - 2
ER -