Crabtree T D, Pelletier S J, Antevil J L, Gleason T G, Pruett T L, Sawyer R G
Surgical Infectious Disease Laboratory, Department of Surgery, University of Virginia, Charlottesville, Virginia 22906, USA.
World J Surg. 2001 Jun;25(6):739-44. doi: 10.1007/s00268-001-0025-4.
The presence of fever and leukocytosis have traditionally been utilized as important diagnostic markers of infection despite some who question their reliability. To examine this point, the role of fever and leukocytosis as diagnostic and prognostic indicators for surgical infections was evaluated. A prospective observational study was performed on all patients with suspected infection in 1997 on the general surgical services at a university hospital. Fever was defined as maximum temperature (Tmax) > or = 38.5 degrees C, and leukocytosis was defined as a white blood cell (WBC) count > or = 11,000/microl. Among all infections, patients presenting with a Tmax > or = 38.5 degrees C were younger (51.3 +/- 1.1 vs. 53.8 +/- 0.9 years, p = 0.005) and had a higher APACHE II score (15.1 +/- 0.5 vs. 11.4 +/- 0.4; p < 0.001). By logistic regression analysis chronic renal insufficiency was associated with a Tmax < 38.5 degrees C [odds ratio (OR) 0.371, 95% confidence interval (CI) 0.195-0.704], and chronic steroid therapy was associated with a WBC count < 11,000/microl (OR 0.556, 95% CI 0.335-0.921). In addition, infected transplant patients were more likely to present with a Tmax < 38.5 degrees C and a WBC count < 11,000/microl (OR 0.195, 95% CI 0.075-0.502). Mortality rates for infected patients with a Tmax < 38.5 degrees C or > 38.5 degrees C were 11.6% and 12.9%, respectively (p < 0.7), and the lengths of stay were 14 +/- 1 and 18 +/- 1 days, respectively (p < 0.03). Mortality rates for patients with a WBC count < 11,000/microl or > 11,000/microl were 4.7% and 18.6%, respectively (p < 0.001), and the lengths of stay were 14 +/- 1 and 19 +/- 1 days, respectively (p < 0.001). In the setting of infection, chronic renal insufficiency and chronic steroid therapy are associated with suppression of fever and leukocytosis, respectively. Transplantation is an independent predictor of infection in patients presenting without fever or leukocytosis. Leukocytosis, but not fever, may be predictive of hospital mortality in infected surgical patients.
传统上，发热和白细胞增多一直被用作感染的重要诊断标志物，尽管有些人质疑其可靠性。为了探讨这一点，我们评估了发热和白细胞增多作为外科感染诊断和预后指标的作用。1997年，在一所大学医院的普通外科对所有疑似感染患者进行了一项前瞻性观察研究。发热定义为最高体温（Tmax）≥38.5℃，白细胞增多定义为白细胞（WBC）计数≥11,000/微升。在所有感染患者中，Tmax≥38.5℃的患者更年轻（51.3±1.1岁 vs. 53.8±0.9岁，p = 0.005），且急性生理与慢性健康状况评分系统（APACHE II）得分更高（15.1±0.5 vs. 11.4±0.4；p < 0.001）。通过逻辑回归分析，慢性肾功能不全与Tmax < 38.5℃相关[比值比（OR）0.371，95%置信区间（CI）0.195 - 0.704]，慢性类固醇治疗与WBC计数 < 11,000/微升相关（OR 0.556，95% CI 0.335 - 0.921）。此外，感染的移植患者更有可能出现Tmax < 38.5℃和WBC计数 < 11,000/微升（OR 0.195，95% CI 0.075 - 0.502）。Tmax < 38.5℃或> 38.
