Geneva Ivayla I, Corsi Anthony J, Searles Madison, Lupone Christina D
Internal Medicine, Crouse Hospital, Syracuse, USA.
Internal Medicine, Zucker School of Medicine at Hofstra/Northwell - North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, USA.
Cureus. 2024 Dec 5;16(12):e75163. doi: 10.7759/cureus.75163. eCollection 2024 Dec.
Background The management of neutropenic fever patients remains challenging. Patients' individual baseline body temperature may provide diagnostic and prognostic value. Methods This study is a retrospective analysis of 92 adults admitted for neutropenic fever to model the length of stay (LOS) and the ability to find a definitive diagnosis using the deviation of patients' temperature on admission from their outpatient baseline, acuity on admission, neutropenia level and persistence, fever persistence, and patients' age. Results Patients' average baseline body temperature was 36.7°C+/-0.3°C - the body temperature had to be over four standard deviations above the baseline to reach the gold standard fever threshold of 38.0°C. Their average fever on admission was 38.1°C. Fever etiologies were identified in 48%, and all constituted infections. Multiple regression modelling demonstrated that a longer LOS of >3 days was predicted by larger deviation from baseline body temperature at admission and by fever persistence at 72 hours post-admission, after correcting for the persistence of severe neutropenia (absolute neutrophil count <500) at 72 hours, age, neutropenia level, and need for intensive care unit admission. A similar model could not predict the ability to identify a fever-explaining diagnosis. Conclusions This pilot project provides support for the use of patients' individual baseline body temperature rather than a pre-established universal fever cutoff in the diagnosis of neutropenic fever. Using a personalized cutoff is expected to avoid missing cases. Further, deviation from patients' baseline body temperature at admission could serve as a predictor for the hospital LOS, which can serve as a potential tool for hospital bed management.
中性粒细胞减少性发热患者的管理仍然具有挑战性。患者的个体基础体温可能具有诊断和预后价值。方法：本研究对92例因中性粒细胞减少性发热入院的成人患者进行回顾性分析，以通过患者入院时体温与门诊基础体温的偏差、入院时的病情严重程度、中性粒细胞减少的程度和持续时间、发热持续时间以及患者年龄来模拟住院时间（LOS）和明确诊断的能力。结果：患者的平均基础体温为36.7°C±0.3°C——体温必须高于基线四个标准差以上才能达到38.0°C的金标准发热阈值。他们入院时的平均体温为38.1°C。48%的患者确定了发热病因，均为感染。多元回归模型显示，在校正72小时时严重中性粒细胞减少（绝对中性粒细胞计数<500）的持续时间、年龄、中性粒细胞减少程度以及入住重症监护病房的需求后，入院时与基础体温的偏差较大以及入院后72小时发热持续存在可预测住院时间>3天。类似的模型无法预测明确发热病因诊断的能力。结论：该试点项目支持在中性粒细胞减少性发热的诊断中使用患者的个体基础体温，而不是预先设定的通用发热临界值。使用个性化临界值有望避免漏诊。此外，入院时与患者基础体温的偏差可作为住院时间的预测指标，这可作为医院床位管理的潜在工具。
