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发热成人进行退烧治疗不能降低死亡和严重不良事件的风险
作者:小柯机器人 发布时间:2022/7/14 16:33:23

瑞典隆德大学Johan Holgersson团队对发热成人的退烧治疗进行了荟萃分析和试验序列分析的系统回顾。2022年7月12日,《英国医学杂志》发表了这一成果。

为了在成人发热人群中比较退烧疗法与无退烧疗法的疗效,研究组在CENTRAL、BIOSIS、CINAHL、MEDLINE、Embase、LILACS、Scopus和Web of Science核心集中检索从建库至2021年7月2日的相关文献,筛选出针对诊断为任何原因发热的成年人进行的随机临床试验。实验干预包括任何退烧治疗,对照干预必须是无退烧治疗(有或没有安慰剂/假手术),对符合资格的试验进行荟萃分析和试验序列分析的系统回顾。

由两位作者独立选择研究,提取数据,并评估偏倚风险。主要结局是全因死亡率和严重不良事件。次要结局是生活质量和非严重不良事件。通过荟萃分析、亚组分析和试验序列分析综合汇总数据,并使用推荐、评估、开发和评价(GRADE)方法对证据进行评估。

42项试验评估了5140名参与者。23个试验评估了11种不同的解热药物,11个试验评估了物理降温,8个试验评估了解热药物和物理降温的组合。在参与者中,3007人患有危重病,1892人患有非危重病,3277人患有感染性发热,1139人患有非感染性发热。所有试验均被评估为存在高偏倚风险。

荟萃分析和试验序列分析表明,退烧治疗降低死亡风险(风险比为1.04;16项试验;高确定性证据)和严重不良事件风险(风险比1.02;16项试验;高确定性证据)的假设可能被推翻。该研究还包括一项评估生活质量的试验,表明退烧治疗组和对照组之间没有差异。荟萃分析和试验序列分析表明,退烧治疗降低非严重不良事件风险的假设既不能得到证实也不能被推翻(风险比为0.92;4个试验;极低确定性证据)。

研究结果表明,退烧治疗似乎不会降低死亡和严重不良事件的风险。

附:英文原文

Title: Fever therapy in febrile adults: systematic review with meta-analyses and trial sequential analyses

Author: Johan Holgersson, Ameldina Ceric, Naqash Sethi, Niklas Nielsen, Janus Christian Jakobsen

Issue&Volume: 2022/07/12

Abstract:

Objective To investigate the effects of fever therapy compared with no fever therapy in a wide population of febrile adults.

Design Systematic review with meta-analyses and trial sequential analyses of randomised clinical trials.

Data sources CENTRAL, BIOSIS, CINAHL, MEDLINE, Embase, LILACS, Scopus, and Web of Science Core Collection, searched from their inception to 2 July 2021.

Eligibility criteria Randomised clinical trials in adults diagnosed as having fever of any origin. Included experimental interventions were any fever therapy, and the control intervention had to be no fever therapy (with or without placebo/sham).

Data extraction and synthesis Two authors independently selected studies, extracted data, and assessed the risk of bias. Primary outcomes were all cause mortality and serious adverse events. Secondary outcomes were quality of life and non-serious adverse events. Aggregate data were synthesised with meta-analyses, subgroup analyses, and trial sequential analyses, and the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results Forty two trials assessing 5140 participants were included. Twenty three trials assessed 11 different antipyretic drugs, 11 trials assessed physical cooling, and eight trials assessed a combination of antipyretic drugs and physical cooling. Of the participants, 3007 were critically ill, 1892 were non-critically ill, 3277 had infectious fever, and 1139 had non-infectious fever. All trials were assessed as being at high risk of bias. Meta-analysis and trial sequential analysis showed that the hypothesis that fever therapy reduces the risk of death (risk ratio 1.04, 95% confidence interval 0.90 to 1.19; I2=0%; P=0.62; 16 trials; high certainty evidence) and the risk of serious adverse events (risk ratio 1.02, 0.89 to 1.17; I2=0%; P=0.78; 16 trials; high certainty evidence) could be rejected. One trial assessing quality of life was included, showing no difference between fever therapy and control. Meta-analysis and trial sequential analysis showed that the hypothesis that fever therapy reduces the risk of non-serious adverse events could be neither confirmed nor rejected (risk ratio 0.92, 0.67 to 1.25; I2=66.5%; P=0.58; four trials; very low certainty evidence).

Conclusions Fever therapy does not seem to affect the risk of death and serious adverse events.

DOI: 10.1136/bmj-2021-069620

Source: https://www.bmj.com/content/378/bmj-2021-069620

 

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj