title: Antipyretic therapy in critically ill patients with established sepsis: a trial sequential analysis.
abstract: OBJECTIVE
  antipyretic therapy for patients with sepsis has long been debated. The present study aimed to explore the beneficial effect of antipyretic therapy for ICU patients with sepsis.
  
  
  METHODS
  systematic review and trial sequential analysis of randomized controlled trials.
  
  
  METHODS
  Pubmed, Scopus, EBSCO and EMBASE were searched from inception to August 5, 2014.
  
  
  METHODS
  Mortality was dichotomized as binary outcome variable and odds ratio (OR) was chosen to be the summary statistic. Pooled OR was calculated by using DerSimonian and Laird method. Statistical heterogeneity was assessed by using the statistic I2. Trial sequential analysis was performed to account for the small number of trials and patients.
  
  
  RESULTS
  A total of 6 randomized controlled trials including 819 patients were included into final analysis. Overall, there was no beneficial effect of antipyretic therapy on mortality risk in patients with established sepsis (OR: 1.02, 95% CI: 0.50-2.05). The required information size (IS) was 2582 and our analysis has not yet reached half of the IS. The Z-curve did not cross the O'Brien-Fleming α-spending boundary or reach the futility, indicating that the non-significant result was probably due to lack of statistical power.
  
  
  CONCLUSIONS
  our study fails to identify any beneficial effect of antipyretic therapy on ICU patients with established diagnosis of sepsis. Due to limited number of total participants, more studies are needed to make a conclusive and reliable analysis.
authors.affiliation: Department of critical care medicine, Jinhua municipal central hospital, Jinhua hospital of Zhejiang university, Zhejiang, P.R.China.
authors.forename: Zhongheng
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D058633:Antipyretics / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016638:Critical Illness; D016208:Databases, Factual; D006801:Humans; D007362:Intensive Care Units; D016017:Odds Ratio; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D058633:Antipyretics