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Early peak temperature and mortality in critically ill patients with or without infection
Critical Carevolume 15, Article number: P24 (2011)
To determine whether fever is associated with reduced risk of death in patients admitted to an ICU with infection compared with other patients.
A retrospective cohort study using a database of Australian and New Zealand (ANZ) ICU admissions as a development cohort and a database of UK ICU admissions as a validation cohort. The sample included 129 ICUs in ANZ and 201 ICUs in the UK. The ANZ development cohort consisted of 269,078 patients and the UK validation cohort consisted of 366,973 patients. All patients were admitted to an ICU between 2005 and 2009. A total of 29,083/269,078 (10.8%) ANZ patients and 103,191/366,973 (28.1%) UK patients were categorised as having an infection at the time of ICU admission. The main outcome measures were the association between peak temperature in the first 24 hours after ICU admission and in-hospital mortality in patients admitted with or without infection.
In the ANZ cohort, adjusted in-hospital mortality risk progressively decreased with increasing peak temperature in patients with infection. Relative to 36.5 to 36.9°C, the lowest risk was at 39 to 39.4°C (adjusted OR = 0.56; 95% CI = 0.48 to 0.66). In patients without infection, the adjusted mortality risk progressively increased above 39.0°C (adjusted OR = 2.07 at ≥40.0°C; 95% CI = 1.68 to 2.55). In the UK cohort, findings were similar with adjusted odds ratios at corresponding temperatures of 0.77 (95% CI = 0.71 to 0.85) and 1.94 (95% CI = 1.60 to 2.34) for the infection and non-infection groups, respectively. See Figures 1 and 2.
Peak temperature in the first 24 hours in the ICU is associated with decreased in-hospital mortality in critically ill patients with an infection; randomised trials are needed to compare the effect on mortality of controlling fever against a permissive approach to fever management in such patients.
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