Dai Yu-Tzu, Lu Shu-Hua, Chen Yee-Chun, Ko Wen-Je
Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
School of Nursing, China Medical University, Taichung, Taiwan Department of Nursing, China Medical University Hospital, Taichung, Taiwan
Biol Res Nurs. 2015 Oct;17(5):469-77. doi: 10.1177/1099800414554683. Epub 2014 Oct 12.
Fever is a complex and major sign of a patient's acute response to infection. However, analysis of the risks and benefits associated with the change in body temperature of an infected host remains controversial.
To examine the relationship between the intensity of the change in body temperature and the mortality of patients with hospital-acquired bacteremia.
A prospective observational study.
Subjects were hospitalized adult patients who developed clinical signs of infection 48 hr or more after admission and had documented bacterial growth in blood culture. The maximum body temperature (maxTe) during the early period of infection measurements (i.e., the day before, the day of, and 2 days after the day of blood culture) was used to indicate the intensity of the body temperature response. Patients were categorized as discharged alive or died in hospital. Cox regression analysis was employed to analyze the data.
The cohort consisted of 502 subjects. The mean maxTe of subjects was 38.6°C, and 14.9% had a maxTe lower than 38.0°C. The in-hospital mortality rate was 18.9%. The highest in-hospital mortality was found in subjects with a maxTe lower than 38°C (30.7%). Multivariate Cox regression analysis determined that the maxTe and the severity of comorbidity are the two variables associated with in-hospital mortality.
Lack of a robust febrile response may be associated with greater risk of mortality in patients with bacteremia. Clinicians must be vigilant in identifying patients at risk for a blunted febrile response to bacteremia for more intensive monitoring.
发热是患者对感染急性反应的一个复杂且主要的体征。然而，对感染宿主体温变化相关风险和益处的分析仍存在争议。
研究体温变化强度与医院获得性菌血症患者死亡率之间的关系。
一项前瞻性观察性研究。
研究对象为入院48小时或更长时间后出现感染临床体征且血培养有细菌生长记录的住院成年患者。感染早期测量期间（即血培养前一天、当天及后两天）的最高体温（maxTe）用于表示体温反应强度。患者分为存活出院或院内死亡。采用Cox回归分析对数据进行分析。
该队列由502名受试者组成。受试者的平均maxTe为38.6°C，14.9%的受试者maxTe低于38.0°C。院内死亡率为18.9%。maxTe低于38°C的受试者院内死亡率最高（30.7%）。多变量Cox回归分析确定maxTe和合并症严重程度是与院内死亡率相关的两个变量。
菌血症患者缺乏强烈的发热反应可能与更高的死亡风险相关。临床医生必须警惕识别出对菌血症发热反应减弱的高危患者，以便进行更密切的监测。
