Pyrexia: aetiology in the ICU

Niven, Daniel J.; Laupland, Kevin B.

doi:10.1186/s13054-016-1406-2

Critical Care

Table 1 Studies reporting the aetiology of pyrexia in immunocompetent patients admitted to adult ICUs with or without an acute neurological condition

From: Pyrexia: aetiology in the ICU

						Aetiology
Study	Setting	Design	Total patients (n)	Episodes of pyrexia (n)	Pyrexia definition (°C)	Infectious diagnosis (n, %)^a	Noninfectious diagnosis (n, %)^a
No acute neurological condition
Circiumaru et al., 1999 [56]	Medical–surgical ICU	Prospective observational study	93	70	≥38.4	Total (37, 53) Respiratory (15, 21) BSI (9, 13) Abdominal (5, 7) Other (8, 11)	Total (33, 47) ARDS (4, 6) MI (3, 4) Vasculitides (2, 3) Pancreatitis (1, 1) Atelectasis (1, 1) GVHD (1, 1) ICH (1, 1) Unclear (20, 29)^b
Peres Bota et al., 2004 [57]	Medical–surgical ICU	Prospective observational study	493	139	≥38.3	Total (76, 55)	Total (63, 45) Postoperative (27, 19) Cerebral hemorrhage (20, 14) Trauma (5, 4) ARDS (3, 2) MI (2, 1) Pancreatitis (3, 2) GI bleed (3, 2)
Barie et al., 2004 [2]	Surgical ICU	Prospective observational study	2419	626	≥38.2	Total (286, 46)^c	Total (330, 53)^c
Laupland et al., 2008 [3]	3 medical–surgical ICUs, 1 CVICU	Retrospective observational study	20,466^d	10,730	≥38.3	Culture-positive (1847, 17) BSI (1004, 9)	Culture-negative (8883, 83)
Niven et al., 2011 [36]	3 medical–surgical ICUs, 1 CVICU	Retrospective observational study	7535	100^e	≥38.3	Total (73, 73) Pneumonia (51, 51) BSI (6, 6) Other (15, 15)	Total (27, 27)
Gozzoli et al., 2001 [58]	Surgical ICU	RCT	38	38	≥38.5	Total (18, 47)	Total (20, 53)
Niven et al., 2013 [59]	2 medical–surgical ICUs	RCT	26	26	≥38.3	Total (23, 88) Respiratory (15, 58) UTI (2, 8) BSI (1, 4) Other (5, 19)	Total (3, 12)
Schortgen et al., 2012 [11]	7 medical–surgical ICUs	RCT	200	200	>38.3	Total (200, 100)^f Lungs (138, 69) Abdomen (13, 7) Genitourinary (12, 6) Other (28, 14) Unknown (9, 5)	Not applicable
Young et al., 2015 [12]	23 medical–surgical ICUs	RCT	700	700	>38.0	Total (700, 100)^f Respiratory (237, 34) Abdominal (92, 13) UTI (68, 10) BSI (42, 6) Skin/soft tissue (54, 8) Other (207, 30)	Not applicable
Acute neurological condition
Commichau et al., 2003 [49]	Neurological ICU	Prospective observational study	387	87	≥38.3	Total (45, 52)^g Respiratory (37, 42) Clostridium difficile (4, 4) UTI (3, 3) Sinusitis (1, 1)	Total (2, 2) DVT (2, 2)
Rabinstein et al., 2007 [45]	Neurological ICU	Prospective observational study	93	93	≥38.3	Total (62, 67) Respiratory (46, 49) Other (16, 17)	Total (31, 33) Central fever (27, 29) Alcohol withdrawal (3, 3) Phenytoin toxicity (1, 1)
Hocker et al., 2013 [51]	Neurological ICU	Retrospective observational study	526	526	>38.3	Total (280, 53)	Total (246, 47)

^aProportion refers to percentage of total number of pyrexia episodes
^bInconsistencies in reporting of pyrexia aetiologies; total number infectious and noninfectious aetiologies did not total the number of pyrexia episodes
^cDetailed data for infectious and noninfectious aetiologies presented in graphical format only
^dA total of 24,204 ICU admissions among 20,466 patients
^eConvenience sample of 100 randomly selected patients. Total number of patients with fever during study period was 2216
^fBoth Schortgen et al. [11] and Young et al. [12] preferentially enrolled patients with suspected or confirmed infection
^gForty-two pyrexia episodes did not have a clear aetiology
ARDS acute respiratory distress syndrome, BSI bloodstream infection, CVICU cardiovascular intensive care unit, DVT deep vein thrombosis, GI gastrointestinal, GVHD graft versus host disease, ICH intracerebral hemorrhage, MI myocardial infarction, RCT randomized controlled trial, UTI urinary tract infection

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