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Learning Objective 1: The learner will be able to describe the association of febrile response and mortality rate of patients with blood stream infection.
Learning Objective 2: The learner will be able to rethink about the effects of fever on health outcomes of infected patients.
This study is designed to examine the relationship between intensity of fever and mortality in patients with blood stream infection (BSI).
Methods:
This study used a prospective, repeated measure, and predictive design. Two indicators were used to measure febrile response of patients including: maximum temperature during the period of 16 observation days (max T), and maximum body temperature during early period of infection (1 day prior and 2days after the day of blood culture, max Te). The patients with bloodstream infection were recruited. Body temperature was continually observed from five days prior to the performing day of sample collection for blood culture, until ten days after day of blood sample collection. The patients were followed until discharge from hospital or deceased. T-tests, ANOVA, Pearson correlation, and multiple regression were used to analyze the predictive factors.
Results:
1. 519 patients enrolled in the study. The mean age was 61.3 years (range from 19 to 107).
2. The mean of max T of BSI was 38.73°C. C. Age (r=-.188, p=.000), severity of co-morbidity(r=-.089, p=.042) , and serum albumin (r=.115, p=.033) were correlated with max T. ANOVA revealed that there were microbial classification difference (F=5.119, p=.000) in mean of max T
3. The total mortality rate of BSI patients is 19.3%. . The results indicated max Te was associated with mortality of patients with BSI (X2= 13.549, P=0.001). Patients with a high fever (max Te ³a 39.5°C) had lower mortality (6%) than patients with an afebrile (max Te < 37.8°C, mortality rate 31.3%) and low to moderate fever ( max Te 37.9 - 39.4°C, mortality rate 19.6%).
Conclusion:
A stronger febrile response may be protective to patients with blood stream infection. Further study to verify the relationship between fever response and mortality of patients with other site infection is warranted.