Journal article
Fever in the ICU: A Predictor of Mortality in Mechanically Ventilated COVID-19 Patients
Journal of intensive care medicine, v 36(4), pp 484-493
01 Apr 2021
PMID: 33317374
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose:
While fever may be a presenting symptom of COVID-19, fever at hospital admission has not been identified as a predictor of mortality. However, hyperthermia during critical illness among ventilated COVID-19 patients in the ICU has not yet been studied. We sought to determine mortality predictors among ventilated COVID-19 ICU patients and we hypothesized that fever in the ICU is predictive of mortality.
Materials and Methods:
We conducted a retrospective cohort study of 103 ventilated COVID-19 patients admitted to the ICU between March 14 and May 27, 2020. Final follow-up was June 5, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded.
Results:
103 patients were included, 40 survived and 63(61.1%) died. Deceased patients were older {66 years[IQR18] vs 62.5[IQR10], (p = 0.0237)}, more often male {48(68%) vs 22(55%), (p = 0.0247)}, had lower initial oxygen saturation {86.0%[IQR18] vs 91.5%[IQR11.5], (p = 0.0060)}, and had lower pH nadir than survivors {7.10[IQR0.2] vs 7.30[IQR0.2] (p < 0.0001)}. Patients had higher peak temperatures during ICU stay as compared to hospital presentation {103.3 degrees F[IQR1.7] vs 100.0 degrees F[IQR3.5], (p < 0.0001)}. Deceased patients had higher peak ICU temperatures than survivors {103.6 degrees F[IQR2.0] vs 102.9 degrees F[IQR1.4], (p = 0.0008)}. Increasing peak temperatures were linearly associated with mortality. Febrile patients who underwent targeted temperature management to achieve normothermia did not have different outcomes than those not actively cooled. Multivariable analysis revealed 60% and 75% higher risk of mortality with peak temperature greater than 103 degrees F and 104 degrees F respectively; it also confirmed hyperthermia, age, male sex, and acidosis to be predictors of mortality.
Conclusions:
This is one of the first studies to identify ICU hyperthermia as predictive of mortality in ventilated COVID-19 patients. Additional predictors included male sex, age, and acidosis. With COVID-19 cases increasing, identification of ICU mortality predictors is crucial to improve risk stratification, resource management, and patient outcomes.
Metrics
Details
- Title
- Fever in the ICU: A Predictor of Mortality in Mechanically Ventilated COVID-19 Patients
- Creators
- Rachel L. Choron - Johnson UniversityChristopher A. Butts - Johnson UniversityChristopher Bargoud - Johnson UniversityNicole J. Krumrei - Johnson UniversityAmanda L. Teichman - Johnson UniversityMary E. Schroeder - Johnson UniversityMichelle T. Bover Manderski - BiostatJenny Cai - Johnson UniversityCherry Song - Johnson UniversityMichael B. Rodricks - Johnson UniversityMatthew Lissauer - Johnson UniversityRajan Gupta - Johnson University
- Publication Details
- Journal of intensive care medicine, v 36(4), pp 484-493
- Publisher
- Sage
- Number of pages
- 10
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000624034000001
- Scopus ID
- 2-s2.0-85097602126
- Other Identifier
- 991021929614604721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine