Authors: Traves D Crabtree Shawn J Pelletier Jared L Antevil Thomas G Gleason Timothy L Pruett Robert G Sawyer
Publish Date: 2014/02/20
Volume: 25, Issue: 6, Pages: 739-744
Abstract
The presence of fever and leukocytosis have traditionally been utilized as important diagnostic markers of infection despite some who question their reliability To examine this point the role of fever and leukocytosis as diagnostic and prognostic indicators for surgical infections was evaluated A prospective observational study was performed on all patients with suspected infection in 1997 on the general surgical services at a university hospital Fever was defined as maximum temperature Tmax ≥ 385°C and leukocytosis was defined as a white blood cell WBC count ≥ 11000/μl Among all infections patients presenting with a Tmax ≥ 385°C were younger 513 ± 11 vs 538 ± 09 years p= 0005 and had a higher APACHE II score 151 ± 05 vs 114 ± 04 p 0001 By logistic regression analysis chronic renal insufficiency was associated with a Tmax 385°C odds ratio OR 0371 95 confidence interval CI 0195–0704 and chronic steroid therapy was associated with a WBC count 11000/μl OR 0556 95 CI 0335–0921 In addition infected transplant patients were more likely to present with a Tmax 385°C and a WBC count 11000/μl OR 0195 95 CI 0075–0502 Mortality rates for infected patients with a Tmax 385°C or 385°C were 116 and 129 respectively p 07 and the lengths of stay were 14 ± 1 and 18 ± 1 days respectively p 003 Mortality rates for patients with a WBC count 11000/μl or 11000/μl were 47 and 186 respectively p 0001 and the lengths of stay were 14 ± 1 and 19 ± 1 days respectively p 0001 In the setting of infection chronic renal insufficiency and chronic steroid therapy are associated with suppression of fever and leukocytosis respectively Transplantation is an independent predictor of infection in patients presenting without fever or leukocytosis Leukocytosis but not fever may be predictive of hospital mortality in infected surgical patients
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