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Correspondence |

Fever Control and Sepsis MortalityFever Control and Sepsis Mortality FREE TO VIEW

Hsiu-Nien Shen, MD
Author and Funding Information

From the Department of Intensive Care Medicine, Chi Mei Medical Center, and Department of Public Health, College of Medicine, National Cheng Kung University.

Correspondence to: Hsiu-Nien Shen, MD, Department of Intensive Care Medicine, Chi Mei Medical Center, No. 901 Chung-Hwa Rd, Yong-Kang District, Tainan, Taiwan; e-mail: hsiunian@gmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):666-667. doi:10.1378/chest.13-2644
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To the Editor:

I read with interest a recent point editorial by Mohr and Doerschug1 published in CHEST (October 2013) on antipyretic therapy for febrile patients in septic shock. The authors stated that “the magnitude of fever has been associated with higher mortality in sepsis,”1 which is incorrect. In fact, results of the cited article2 indicated that the magnitude of fever is associated with higher mortality in patients without sepsis, not in those with sepsis. A correction of the abstract of the original article has been posted.3

Furthermore, as Drewry and Hotchkiss4 pointed out, external cooling for febrile patients with severe septic shock is associated with a trend toward decreased ICU mortality but not hospital mortality.5 Given the very poor quality of a patient’s life in the ICU, survival analyses for short-term outcomes have been considered not appropriate.6 Sepsis-associated mortality is shown to reach a plateau at 90 days after ICU admission.7 Therefore, I believe that without evidence of a longer-term benefit, external cooling should not be given routinely to febrile patients in septic shock.

References

Mohr NM, Doerschug KC. Point: should antipyretic therapy be given routinely to febrile patients in septic shock? Yes. Chest. 2013;144(4):1096-1098. [CrossRef] [PubMed]
 
Lee BH, Inui D, Suh GY, et al; Fever and Antipyretic in Critically Ill patients Evaluation (FACE) Study Group. Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care. 2012;16(1):R33. [CrossRef] [PubMed]
 
Lee BH, Inui D, Suh GY, et al; Fever and Antipyretic in Critically Ill Patients Evaluation Study Group. Correction: association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care. 2012;16(5):450. [CrossRef] [PubMed]
 
Drewry AM, Hotchkiss RS. Counterpoint: should antipyretic therapy be given routinely to febrile patients in septic shock? No. Chest. 2013;144(4):1098-1101. [CrossRef] [PubMed]
 
Schortgen F, Clabault K, Katsahian S, et al. Fever control using external cooling in septic shock: a randomized controlled trial. Am J Respir Crit Care Med. 2012;185(10):1088-1095. [CrossRef] [PubMed]
 
Schoenfeld D. Survival methods, including those using competing risk analysis, are not appropriate for intensive care unit outcome studies. Crit Care. 2006;10(1):103. [CrossRef] [PubMed]
 
Taori G, Ho KM, George C, et al. Landmark survival as an end-point for trials in critically ill patients—comparison of alternative durations of follow-up: an exploratory analysis. Crit Care. 2009;13(4):R128. [CrossRef] [PubMed]
 

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References

Mohr NM, Doerschug KC. Point: should antipyretic therapy be given routinely to febrile patients in septic shock? Yes. Chest. 2013;144(4):1096-1098. [CrossRef] [PubMed]
 
Lee BH, Inui D, Suh GY, et al; Fever and Antipyretic in Critically Ill patients Evaluation (FACE) Study Group. Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care. 2012;16(1):R33. [CrossRef] [PubMed]
 
Lee BH, Inui D, Suh GY, et al; Fever and Antipyretic in Critically Ill Patients Evaluation Study Group. Correction: association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care. 2012;16(5):450. [CrossRef] [PubMed]
 
Drewry AM, Hotchkiss RS. Counterpoint: should antipyretic therapy be given routinely to febrile patients in septic shock? No. Chest. 2013;144(4):1098-1101. [CrossRef] [PubMed]
 
Schortgen F, Clabault K, Katsahian S, et al. Fever control using external cooling in septic shock: a randomized controlled trial. Am J Respir Crit Care Med. 2012;185(10):1088-1095. [CrossRef] [PubMed]
 
Schoenfeld D. Survival methods, including those using competing risk analysis, are not appropriate for intensive care unit outcome studies. Crit Care. 2006;10(1):103. [CrossRef] [PubMed]
 
Taori G, Ho KM, George C, et al. Landmark survival as an end-point for trials in critically ill patients—comparison of alternative durations of follow-up: an exploratory analysis. Crit Care. 2009;13(4):R128. [CrossRef] [PubMed]
 
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