Circiumaru B, Baldock G, Cohen J
Department of Infectious Diseases, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
Intensive Care Med. 1999 Jul;25(7):668-73. doi: 10.1007/s001340050928.
To determine the epidemiology of fever on the intensive care unit (ICU).
Prospective, observational study.
Nine-bed general ICU in a 500-bed tertiary care inner city institution.
100 consecutive admissions of 93 patients over a 4-month period between July and October 1996.
All patients were seen and examined by one investigator within 24 h of ICU admission. Patients were followed up on a daily basis throughout their ICU stay, and all clinical and laboratory data were recorded during the admission.
Fever (core temperature > or = 38.4 degrees C) was present in 70% of admissions, and it was caused by infective and non-infective processes in approximately equal number. Most fevers occurred early in the course of the admission, within the first 1-2 days, and most lasted less than 5 days. The median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15 (+/- 0.6). The 70 episodes associated with fever at any time were associated with a significantly higher APACHE II score on admission than the afebrile episodes (15.8 +/- 6.1 vs 12.1 +/- 6.7, p = 0.04). The most common cause of non-infective fever was in the group designated post-operative fever (n = 34). All the patients in the post-operative fever group were febrile on day 0 or day 1; their mean admission APACHE score was 12.4 (+/- 4.4) compared to 15.9 (+/- 7.1) for the remaining patients (p = 0.01). Fever alone was not associated with a higher mortality: 26/70 (37%) of febrile patients died, compared to 8/30 (27%) of afebrile patients, (chi 2 = 1.23, p = 0.38). Prolonged fever (> 5 days) occurred in 16 patients. In 13 cases, fever was due to infection, and in the remaining 3 both infective and non-infective processes occurred concurrently. The mortality in the group with prolonged fever was 62.5% (10/16) compared to 29.6% (16/54) in patients with fever of less than 5 days' duration, a highly significant difference (p < 0.0001).
Fever is a common event on the intensive care unit. It usually occurs early in the course, is frequently non-infective and is often benign. Prolonged fever is associated with a poor outcome. Post-operative fever is a well-recognised but poorly defined syndrome which requires further study.
确定重症监护病房（ICU）发热的流行病学特征。
前瞻性观察性研究。
一家拥有500张床位的市中心三级医疗机构中的一间有9张床位的综合ICU。
1996年7月至10月的4个月期间，连续收治93例患者，共100次入院。
所有患者在入住ICU后24小时内由一名研究人员进行检查。在患者整个ICU住院期间每天进行随访，并记录入院期间所有临床和实验室数据。
70%的入院患者出现发热（核心体温≥38.4℃），感染性和非感染性原因导致发热的病例数大致相等。大多数发热发生在入院早期，即头1 - 2天内，且大多数持续时间不到5天。急性生理与慢性健康状况评价（APACHE）II评分中位数为15（±0.6）。任何时候出现发热的70例患者入院时的APACHE II评分显著高于未发热患者（15.8±6.1对12.1±6.7，p = 0.04）。非感染性发热最常见的原因是术后发热组（n = 34）。术后发热组所有患者在第0天或第1天发热；他们的平均入院APACHE评分为12.4（±4.4），而其余患者为15.9（±7.1）（p = 0.01）。仅发热与较高死亡率无关：发热患者中有26/70（37%）死亡，未发热患者中有8/30（27%）死亡，（卡方 = 1.23，p = 0.38）。16例患者出现持续性发热（> 5天）。其中13例发热是由感染引起，其余3例感染性和非感染性因素同时存在。持续性发热组的死亡率为62.5%（10/16），而发热持续时间少于5天的患者死亡率为29.6%（16/54），差异极具显著性（p < 0.0001）。
发热在重症监护病房是常见事件。通常发生在病程早期，多为非感染性且往往是良性的。持续性发热与不良预后相关。术后发热是一种公认但定义不明确的综合征，需要进一步研究。
