Seguin Philippe, Roquilly Antoine, Mimoz Olivier, Le Maguet Pascale, Asehnoune Karim, Biederman Sébastien, Carise Elsa, Malledant Yannick
Crit Care. 2012 Aug 13;16(4):R150. doi: 10.1186/cc11465.
Prolonged fever occurs with infectious and noninfectious diseases but is poorly studied in intensive care units. The aims of this prospective multicenter noninterventional study were to determine the incidence and etiologies of prolonged fever in critically ill patients and to compare outcomes for prolonged fever and short-lasting fever.
The study involved two periods of 2 months each, with 507 patients hospitalized ≥ 24 hours. Fever was defined by at least one episode of temperature ≥ 38.3 °C, and prolonged fever, as lasting > 5 days. Backward stepwise logistic regression was performed to identify the independent factors associated with prolonged fever versus short-lasting fever.
Prolonged or short-lasting fever occurred in 87 (17%) and 278 (55%) patients, respectively. Infectious and noninfectious causes were found in 54 (62%) and 27 (31%) of 87 patients, respectively; in six patients (7%), prolonged fever remained unexplained. The two most common sites of infection were ventilator-associated pneumonia (n = 25) and intraabdominal infection (n = 13). Noninfectious fever (n = 27) was neurogenic in 19 (70%) patients and mainly associated with cerebral injury (84%). Independent risk factors for prolonged fever were cerebral injury at admission (OR = 5.03; 95% CI, 2.51 to 10.06), severe sepsis (OR = 2.79; 95% CI, 1.35 to 5.79), number of infections (OR = 2.35; 95% CI, 1.43 to 3.86), and mechanical-ventilation duration (OR = 1.05; 95% CI, 1.01 to 1.09). Older patients were less likely to develop prolonged fever. ICU mortality did not differ between the two groups.
Prolonged fever was common, mainly due to severe infections, particularly ventilator-associated pneumonia, and mixed infectious causes were frequent, warranting systematic and careful search for multiple causes. Neurogenic fever was also especially frequent.
长期发热可见于感染性和非感染性疾病，但在重症监护病房中对此研究较少。这项前瞻性多中心非干预性研究的目的是确定重症患者长期发热的发生率和病因，并比较长期发热和短期发热患者的预后。
该研究包括两个为期2个月的阶段，共有507名住院时间≥24小时的患者。发热定义为至少有一次体温≥38.3°C，长期发热定义为持续>5天。采用向后逐步逻辑回归分析来确定与长期发热和短期发热相关的独立因素。
分别有87名（17%）和278名（55%）患者出现长期或短期发热。87名患者中，分别有54名（62%）和27名（31%）患者的病因是感染性和非感染性的；6名患者（7%）的长期发热病因不明。两个最常见的感染部位是呼吸机相关性肺炎（n = 25）和腹腔内感染（n = 13）。非感染性发热（n = 27）在19名（70%）患者中是神经源性的，主要与脑损伤有关（84%）。长期发热的独立危险因素包括入院时脑损伤（OR = 5.03；95%CI，2.51至10.06）、严重脓毒症（OR = 2.79；95%CI，1.35至5.79）、感染次数（OR = 2.35；95%CI，1.43至3.86）和机械通气时间（OR = 1.05；95%CI，1.01至1.09）。老年患者发生长期发热的可能性较小。两组患者的重症监护病房死亡率无差异。
长期发热很常见，主要原因是严重感染，尤其是呼吸机相关性肺炎，且混合性感染病因很常见，需要系统、仔细地查找多种病因。神经源性发热也尤为常见。
