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Antipyretic Therapy in Critically Ill Septic Patients: A Systematic Review and Meta-Analysis
Anne M Drewry1, Enyo A Ablordeppey, Ellen T Murray
11Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO. 2Departments of Emergency Medicine and Anesthesiology, Washington University School of Medicine, St. Louis, MO. 3University of Missouri-Columbia School of Medicine, Columbia, MO. 4Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 5Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO.
Critical Care Medicine
|February 22, 2017
Summary
Antipyretic therapy in critically ill septic adults did not reduce mortality. This treatment effectively lowered body temperature but did not impact shock reversal or nosocomial infections.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Fever is a common symptom in sepsis, and antipyretic therapies are often used to manage it.
- The impact of antipyretic therapy on mortality in critically ill septic patients remains unclear.
Purpose of the Study:
- To conduct a meta-analysis evaluating the effect of antipyretic therapy on mortality in critically ill adult patients with sepsis.
- To assess the influence of antipyretics on secondary outcomes such as shock reversal and nosocomial infections.
Main Methods:
- Comprehensive literature searches were performed across multiple databases (Ovid Medline, Embase, Scopus, CINAHL, Cochrane, NHS EED, ClinicalTrials.gov) up to February 2016.
- Inclusion criteria focused on observational or randomized studies of septic patients, antipyretic use, and reported mortality, excluding pediatric or neurologically injured populations.
- Data extraction and quality assessment were conducted independently by two reviewers, with separate analyses for randomized and observational studies.
Main Results:
- The meta-analysis included eight randomized studies (1,507 patients) and eight observational studies (17,432 patients).
- Antipyretic therapy demonstrated no significant reduction in 28-day or hospital mortality in either randomized (RR, 0.93; 95% CI, 0.77-1.13) or observational studies (OR, 0.90; 95% CI, 0.54-1.51).
- No significant differences were observed in shock reversal or acquisition of nosocomial infections; however, antipyretic therapy did significantly decrease body temperature (MD, -0.38°C; 95% CI, -0.63 to -0.13).
Conclusions:
- Antipyretic treatment does not appear to significantly improve 28-day or hospital mortality rates in adult sepsis patients.
- While effective in reducing fever, antipyretics did not confer benefits regarding key clinical outcomes like shock reversal or infection rates.
- Further research may be warranted to explore specific patient subgroups or alternative therapeutic strategies.
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