Should We Treat Fever in Patients with Sepsis?

Authors: Drewry AM et al., Crit Care Med 2017 Feb 17;

A meta-analysis showed that antipyretic therapy did not reduce 28-day mortality.

Fever is certainly a sign of infection. But does treatment of fever improve outcomes in patients with sepsis?

To find out, investigators conducted a meta-analysis of eight randomized trials (1507 patients) and six observational studies (2058 patients) that compared outcomes in adult patients with sepsis according to whether or not they were treated with antipyretics. Two additional observational studies examined early mortality in 15,374 patients.

The analysis showed that the primary outcome of 28-day mortality was not significantly different between patients who received antipyretics versus those who did not (relative risk, 0.93; 95% confidence interval, 0.79–1.09). Moreover, no significant between-group differences were observed in the secondary outcomes of postintervention heart rate, minute ventilation, rates of nosocomial infections, and shock reversal. A significant decrease in early mortality was observed in patients who received antipyretics (RR, 0.68; 95% CI, 0.49–0.92). Given the size and number of included trials, these results are unlikely to be affected by future studies.

Comment

Decreasing early mortality is useless if it doesn’t translate to reduced overall mortality. Focus on aggressive fluid resuscitation and early antibiotics. Antipyresis won’t help your septic patients.