Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
Internal Medicine "H" department, Rambam Health Care Campus, Haifa, Israel.
Am J Emerg Med. 2022 Feb;52:92-98. doi: 10.1016/j.ajem.2021.11.045. Epub 2021 Dec 3.
Fever is a physiologic response to a wide range of pathologies and one of the most common complaints and clinical signs in the emergency medicine department (ED). The association between fever magnitude and clinical outcomes has been evaluated in specific populations with inconsistent results.
In this study we aimed to investigate the association between the degree of fever in the ED and clinical outcomes of hospitalized febrile adult patients.
This was a retrospective single-center cohort study of all the patients with maximal body temperature (BT) ≥ 38.0 °C, as recorded during the ED evaluation, who were hospitalized between January 2015 and December 2020. Patients with heatstroke were excluded. The primary outcome was 30-day all-cause mortality and secondary outcomes were intensive care unit (ICU) admission and development of acute kidney injury (AKI).
Fever was recorded among 8.1% of patients evaluated in the ED. Elevated BT was associated with increased risk of hospital admission (70.3% vs. 49.4%, p < 0.001), 30-day mortality (12.3% vs. 2.6%, p < 0.001), ICU admission (5.7% vs. 2.8%, p < 0.001), and AKI 11.7% vs. 3.8%, p < 0.001). After exclusion of nine patients with heatstroke, 21,252 hospitalized febrile patients were included in the final analysis. BT > 39.7 °C was progressively associated with increased mortality (OR 1.64-2.22, 95% CI 1.16-2.81, p < 0.005) as compared to BT 38.0-38.1 °C. More AKI events were observed in patients with BT > 39.5 °C (OR 1.48-2.91, 95% CI 1.11-3.66, p < 0.007). Temperature between 39.2 and 39.5 °C was associated with lower mortality (OR 0.62-0.71, 95% CI 0.51-0.87, p < 0.001). In a multiple logistic regression analysis BT > 39.9 °C was independently associated with increased mortality and AKI. BT > 39.7 °C was progressively associated with an increased risk of ICU admission.
Among febrile patients admitted to the hospital, BT > 39.5 °C was associated with adverse clinical course, as compared to patients with lower-grade fever (38.0-38.1 °C). These patients should be flagged on arrival to the ED and likely warrant more aggressive evaluation and treatment.
发热是对广泛病理的生理反应，也是急诊医学科（ED）最常见的主诉和临床体征之一。发热程度与临床结局之间的关联已在特定人群中进行了评估，但结果不一致。
本研究旨在探讨 ED 中发热程度与住院发热成年患者临床结局之间的关系。
这是一项回顾性单中心队列研究，纳入了所有在 ED 评估期间记录的最大体温（BT）≥38.0°C 的患者，这些患者于 2015 年 1 月至 2020 年 12 月期间住院。排除中暑患者。主要结局是 30 天全因死亡率，次要结局是入住重症监护病房（ICU）和发生急性肾损伤（AKI）。
ED 评估中有 8.1%的患者出现发热。体温升高与住院风险增加相关（70.3%比 49.4%，p<0.001），30 天死亡率（12.3%比 2.6%，p<0.001），入住 ICU（5.7%比 2.8%，p<0.001）和 AKI（11.7%比 3.8%，p<0.001）。排除 9 例中暑患者后，最终纳入 21252 例住院发热患者进行分析。与 BT 38.0-38.1°C 相比，BT>39.7°C 与死亡率增加呈逐渐相关（OR 1.64-2.22，95%CI 1.16-2.81，p<0.005）。BT>39.5°C 的患者发生更多 AKI 事件（OR 1.48-2.91，95%CI 1.11-3.66，p<0.007）。BT 在 39.2-39.5°C 之间与较低的死亡率相关（OR 0.62-0.71，95%CI 0.51-0.87，p<0.001）。在多因素逻辑回归分析中，BT>39.9°C 与死亡率增加和 AKI 独立相关。BT>39.7°C 与 ICU 入院风险增加呈逐渐相关。
与低级别发热（38.0-38.1°C）患者相比，住院发热患者的 BT>39.5°C 与不良临床病程相关。这些患者到达 ED 时应被标记出来，可能需要更积极的评估和治疗。
