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Abstract
With great interest we read the article by Dr Schoeneberg and colleagues regarding gender-specific differences with respect to outcome in patients with severe traumatic injury. The authors show that, apart from the acute phase after trauma, women have a more favorable trauma severity-adjusted outcome, with shorter ICU and hospital stay and lower sepsis rates. However, a possible mechanism of action behind this difference was not suggested. We hypothesize that, in view of the fact that morbidity and mortality in the post-acute phase after trauma are often caused by infectious complications, gender differences in immunity might explain the observed differences.
Highlights
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2014 and co-published as a series in Critical Care
We review the biology of fever, the significance of the febrile response in animals and humans, and the current evidence-base regarding the utility of treating fever in intensive care patients with infectious diseases
Arguments based on the evolutionary importance of the febrile response do not necessarily apply to critically ill patients who are, by definition, supported beyond the limits of normal physiological homeostasis
Summary
‘Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever’ [1]. The effects of fever on the viability of microbial pathogens Temperatures in the human physiological febrile range cause direct inhibition of some viral and bacterial organisms such as influenza virus [6], Streptococcus pneumonia [7], [8], and Neisseria meningitides [9] which can all cause life-threatening illnesses. As COX catalyzes the generation of prostaglandins from arachidonic acid, this suggests that the pivotal role of PGE2 in the regulation of the thermostatic set-point may be preserved in these species as well as in higher animals Such a common biochemical mechanism to regulate fever across such a diverse group of animals raises the possibility that the febrile response may have evolved in a common ancestor.
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