title: The effect of antipyretic medications on mortality in critically ill patients with infection: a systematic review and meta-analysis.
abstract: BACKGROUND
  Antipyretic medications are widely used in critically ill patients with infection despite evidence supporting a protective, adaptive role of fever.
  
  
  OBJECTIVE
  To assess the mortality risk of antipyretic medications among critically ill patients with infection.
  
  
  METHODS
  A systematic search of MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and PubMed was undertaken to identify randomised controlled trials (RCTs) of antipyretic use among critically ill patients with suspected or confirmed infection that reported mortality. A quantitative meta-analysis of the risk of death was carried out with calculation of the pooled risk of death and standard evaluation of heterogeneity.
  
  
  RESULTS
  Six RCTs investigating the use of paracetamol (1) and non-steroidal anti-inflammatory medications (5) met the inclusion criteria for meta-analysis. The trials were heterogeneous in terms of study populations and interventions, were not primarily designed to evaluate antipyretic effect on mortality risk, and significant confounding was present from the use of other concomitant antipyretic strategies. The pooled estimates of odds ratios for mortality with antipyretic treatment were 0.96 (95% CI, 0.68-1.34) and 1.08 (95% CI, 0.60-1.96) for fixed effects and random effects, respectively, and the I-squared value was 34.9 (95% CI, 0.0-73.9).
  
  
  CONCLUSIONS
  The studies included in this review were insufficient to allow a robust estimate of the effect of pharmacological antipyresis on mortality in critically ill patients with suspected infection. Further RCTs are required to resolve this important area of clinical uncertainty.
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand. Sarah.Jefferies@mrinz.ac.nz
authors.forename: Sarah
authors.initials: S
authors.lastname: Jefferies
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.forename: Paul
authors.initials: P
authors.lastname: Young
authors.forename: Sally
authors.initials: S
authors.lastname: Eyers
authors.forename: Kyle G
authors.initials: KG
authors.lastname: Perrin
authors.forename: C Richard W
authors.initials: CR
authors.lastname: Beasley
mesh_terms: D000818:Animals; D058633:Antipyretics / Q000627:therapeutic use*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D014943:Global Health; D006801:Humans; D007239:Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D015996:Survival Rate / Q000639:trends
chemical_list: D058633:Antipyretics