Risk factors and outcomes for prolonged versus brief fever a prospective cohort study 英文参考文献.docVIP

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Risk factors and outcomes for prolonged versus brief fever a prospective cohort study 英文参考文献.doc

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Risk factors and outcomes for prolonged versus brief fever a prospective cohort study 英文参考文献

Seguinetal.CriticalCare2012,16:R150 /content/16/4/R150 RESEARCH OpenAccess Riskfactorsandoutcomesforprolongedversus brieffever:aprospectivecohortstudy PhilippeSeguin1,2,3*,AntoineRoquilly4,OlivierMimoz5,6,PascaleLeMaguet1,KarimAsehnoune4, SébastienBiederman1,ElsaCarise5andYannickMalledant1,2,3,fortheAtlanReaGroup Abstract Introduction:Prolongedfeveroccurswithinfectiousandnoninfectiousdiseasesbutispoorlystudiedinintensive careunits.Theaimsofthisprospectivemulticenternoninterventionalstudyweretodeterminetheincidenceand etiologiesofprolongedfeverincriticallyillpatientsandtocompareoutcomesforprolongedfeverandshort- lastingfever. Methods:Thestudyinvolvedtwoperiodsof2monthseach,with507patientshospitalized≥24hours.Feverwas definedbyatleastoneepisodeoftemperature≥38.3°C,andprolongedfever,aslasting5days.Backward stepwiselogisticregressionwasperformedtoidentifytheindependentfactorsassociatedwithprolongedfever versusshort-lastingfever. Results:Prolongedorshort-lastingfeveroccurredin87(17%)and278(55%)patients,respectively.Infectiousand noninfectiouscauseswerefoundin54(62%)and27(31%)of87patients,respectively;insixpatients(7%), prolongedfeverremainedunexplained.Thetwomostcommonsitesofinfectionwereventilator-associated pneumonia(n=25)andintraabdominalinfection(n=13).Noninfectiousfever(n=27)wasneurogenicin19 (70%)patientsandmainlyassociatedwithcerebralinjury(84%).Independentriskfactorsforprolongedfeverwere cerebralinjuryatadmission(OR=5.03;95%CI,2.51to10.06),severesepsis(OR=2.79;95%CI,1.35to5.79), numberofinfections(OR=2.35;95%CI,1.43to3.86),andmechanical-ventilationduration(OR=1.05;95%CI,1.01 to1.09).Olderpatientswerelesslikelytodevelopprolongedfever.ICUmortalitydidnotdifferbetweenthetwo groups. Conclusions:Prolongedfeverwascommon,mainlyduetosevereinfections,particularlyventilator-associated pneumonia,andmixedinfectiouscauseswerefrequent,warrantingsystematicandcarefulsearchformultiple causes.Neurogenicfeverwasalsoespeciallyfrequent. Introduction prolonged fever (5days) has not be