Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA.
Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
J Gen Intern Med. 2023 Sep;38(12):2742-2748. doi: 10.1007/s11606-023-08168-6. Epub 2023 Mar 30.
Early recognition and treatment of bacteremia can be lifesaving. Fever is a well-known marker of bacteremia, but the predictive value of temperature has not been fully explored.
To describe temperature as a predictor of bacteremia and other infections.
Retrospective review of electronic health record data.
A single healthcare system comprising 13 hospitals in the United States.
Adult medical patients admitted in 2017 or 2018 without malignancy or immunosuppression.
Maximum temperature, bacteremia, influenza and skin and soft tissue (SSTI) infections based on blood cultures and ICD-10 coding.
Of 97,174 patients, 1,518 (1.6%) had bacteremia, 1,392 (1.4%) had influenza, and 3,280 (3.3%) had an SSTI. There was no identifiable temperature threshold that provided adequate sensitivity and specificity for bacteremia. Only 45% of patients with bacteremia had a maximum temperature ≥ 100.4˚F (38˚C). Temperature showed a U-shaped relationship with bacteremia with highest risk above 103˚F (39.4˚C). Positive likelihood ratios for influenza and SSTI also increased with temperature but showed a threshold effect at ≥ 101.0 ˚F (38.3˚C). The effect of temperature was similar but blunted for patients aged ≥ 65 years, who frequently lacked fever despite bacteremia.
The majority of bacteremic patients had maximum temperatures below 100.4 ˚F (38.0˚C) and positive likelihood ratios for bacteremia increased with high temperatures above the traditional definition of fever. Efforts to predict bacteremia should incorporate temperature as a continuous variable.
早期识别和治疗菌血症可以挽救生命。发热是菌血症的一个众所周知的标志物，但体温的预测价值尚未得到充分探索。
描述体温作为菌血症和其他感染的预测指标。
回顾性电子病历数据审查。
一个由美国 13 家医院组成的单一医疗保健系统。
2017 年或 2018 年无恶性肿瘤或免疫抑制的成年住院患者。
最大体温、菌血症、流感和基于血液培养和 ICD-10 编码的皮肤和软组织（SSTI）感染。
在 97174 例患者中，1518 例（1.6%）发生菌血症，1392 例（1.4%）发生流感，3280 例（3.3%）发生 SSTI。没有确定的体温阈值能为菌血症提供足够的灵敏度和特异性。仅有 45%的菌血症患者的最高体温≥100.4°F（38°C）。体温与菌血症呈 U 型关系，最高风险出现在 103°F（39.4°C）以上。流感和 SSTI 的阳性似然比随体温升高而增加，但在≥101.0°F（38.3°C）时出现阈值效应。对于≥65 岁的患者，体温的影响相似但较为缓和，尽管存在菌血症，但这些患者常无发热。
大多数菌血症患者的最高体温低于 100.4°F（38.0°C），而菌血症的阳性似然比随高于传统发热定义的高温而增加。预测菌血症应将体温作为连续变量纳入考虑。
