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Intensive Care Medicine

, Volume 38, Issue 3, pp 437–444 | Cite as

Early peak temperature and mortality in critically ill patients with or without infection

  • Paul Jeffrey Young
  • Manoj Saxena
  • Richard Beasley
  • Rinaldo Bellomo
  • Michael Bailey
  • David Pilcher
  • Simon Finfer
  • David Harrison
  • John Myburgh
  • Kathryn Rowan
Original

Abstract

Purpose

To determine whether fever is associated with an increased or decreased risk of death in patients admitted to an intensive care unit (ICU) with infection.

Methods

We evaluated the independent association between peak temperature in the first 24 h after ICU admission and in-hospital mortality according to whether there was an admission diagnosis of infection using a database of admissions to 129 ICUs in Australia and New Zealand (ANZ) (n = 269,078). Subsequently, we sought to confirm or refute the ANZ database findings using a validation cohort of admissions to 201 ICUs in the UK (n = 366,973).

Results

A total of 29,083/269,078 (10.8%) ANZ patients and 103,191/366,973 (28.1%) of UK patients were categorised as having an infection. In the ANZ cohort, adjusted in-hospital mortality risk progressively decreased with increasing peak temperature in patients with infection. Relative to the risk at 36.5–36.9°C, the lowest risk was at 39–39.4°C (adjusted OR 0.56; 95% CI 0.48–0.66). In patients without infection, the adjusted mortality risk progressively increased above 39.0°C (adjusted OR 2.07 at 40.0°C or above; 95% CI 1.68–2.55). In the UK cohort, findings were similar with adjusted odds ratios at corresponding temperatures of 0.77 (95% CI 0.71–0.85) and 1.94 (95% CI 1.60–2.34) for infection and non-infection groups, respectively.

Conclusions

Elevated peak temperature in the first 24 h in ICU is associated with decreased in-hospital mortality in critically ill patients with an infection; randomised trials are needed to determine whether controlling fever increases mortality in such patients.

Keywords

Infection Fever Body temperature Antipyresis 

Notes

Acknowledgments

We would like to thank Prof. John Kellum and Prof. Michael Reade for offering their feedback and suggestions on this manuscript. This study was funded by the Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia and the Intensive Care National Audit & Research Centre, London, UK.

Supplementary material

134_2012_2478_MOESM1_ESM.doc (157 kb)
Supplementary material 1 (DOC 157 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Paul Jeffrey Young
    • 1
  • Manoj Saxena
    • 2
    • 3
  • Richard Beasley
    • 4
  • Rinaldo Bellomo
    • 5
    • 6
  • Michael Bailey
    • 6
  • David Pilcher
    • 7
    • 8
  • Simon Finfer
    • 3
    • 9
  • David Harrison
    • 10
  • John Myburgh
    • 2
    • 3
  • Kathryn Rowan
    • 10
  1. 1.Medical Research Institute of New Zealand, Intensive Care ResearchWellington Regional Hospital, Intensive Care UnitWellingtonNew Zealand
  2. 2.St George Clinical SchoolUniversity of New South WalesSydneyAustralia
  3. 3.Division of Critical Care and TraumaGeorge Institute for Global HealthSydneyAustralia
  4. 4.Medical Research Institute of New ZealandWellingtonNew Zealand
  5. 5.Austin Hospital, Intensive Care UnitMelbourneAustralia
  6. 6.Australian and New Zealand Intensive Care Research CentreMonash UniversityMelbourneAustralia
  7. 7.Intensive Care Unit, Alfred HospitalMelbourneAustralia
  8. 8.Centre for Outcome and Resource EvaluationAustralian and New Zealand Intensive SocietyMelbourneAustralia
  9. 9.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  10. 10.Intensive Care National Audit and Research CentreLondonUK

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