Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama city, Okayama 700-8558, Japan.
J Crit Care. 2012 Oct;27(5):428-33. doi: 10.1016/j.jcrc.2011.11.016. Epub 2012 Jan 9.
There is no recommendation on how increased body temperature should be treated in non-neurological critically ill patients. To understand the epidemiology of fever and its association with mortality, we conducted a systematic review of the literature to search for data related to the association between fever and mortality.
We searched MEDLINE and PUBMED related articles and reference lists from January 1978 to July 2011 to select observational studies for assessment of the association of fever with mortality in non-neurological critically ill patients.
We reviewed 1464 articles and found 9 relevant articles. We found that (1) there is no uniform definition of fever, (2) fever (37.5°C to >39.0°C) was not significantly associated with mortality (odds ratio, 1.22; P = .52), and (3) high fever (39.3°C to 39.5°C) was significantly associated with mortality (odds ratio, 2.95; P = .03). We also found that there has been no multicenter prospective observational study including important confounding factors, such as the use of antipyretic treatments, steroids, and extracorporeal circuits.
The limited evidence available suggests that the recommended definition of fever (38.3°C) might be too low to predict increased mortality. Because fever is common in the intensive care unit, there is an urgent need for more studies in this field.
目前尚无关于如何处理非神经危重症患者体温升高的建议。为了了解发热的流行病学及其与死亡率的关系，我们对文献进行了系统回顾，以寻找与发热与死亡率相关的数据。
我们检索了 MEDLINE 和 PUBMED 相关文章以及 1978 年 1 月至 2011 年 7 月的参考文献列表，以选择评估非神经危重症患者发热与死亡率相关性的观察性研究。
我们回顾了 1464 篇文章，发现了 9 篇相关文章。我们发现：（1）发热没有统一的定义；（2）发热（37.5°C 至>39.0°C）与死亡率无显著相关性（比值比，1.22；P=.52）；（3）高热（39.3°C 至 39.5°C）与死亡率显著相关（比值比，2.95；P=.03）。我们还发现，目前还没有包括重要混杂因素（如退热治疗、类固醇和体外循环的使用）的多中心前瞻性观察性研究。
现有证据有限，表明推荐的发热定义（38.3°C）可能过低，无法预测死亡率升高。由于发热在重症监护病房很常见，因此迫切需要在这一领域开展更多的研究。
