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Original Article
Epidemiology
Mortality rates among adult critical care patients with unusual or extreme values of vital signs and other physiological parameters: a retrospective study
Charles Harding, Marybeth Pompei, Dmitriy Burmistrov, Francesco Pompei
Acute Crit Care. 2024;39(2):304-311.   Published online May 13, 2024
DOI: https://doi.org/10.4266/acc.2023.01361
  • 566 View
  • 37 Download
AbstractAbstract PDF
Background
We evaluated relationships of vital signs and laboratory-tested physiological parameters with in-hospital mortality, focusing on values that are unusual or extreme even in critical care settings. Methods: We retrospectively studied Philips Healthcare–MIT eICU data (207 U.S. hospitals, 20142015), including 166,959 adult-patient critical care admissions. Analyzing most-deranged (worst) value measured in the first admission day, we investigated vital signs (body temperature, heart rate, mean arterial pressure, and respiratory rate) as well as albumin, bilirubin, blood pH via arterial blood gas (ABG), blood urea nitrogen, creatinine, FiO2 ABG, glucose, hematocrit, PaO2 ABG, PaCO2 ABG, sodium, 24-hour urine output, and white blood cell count (WBC). Results: In-hospital mortality was ≥50% at extremes of low blood pH, low and high body temperature, low albumin, low glucose, and low heart rate. Near extremes of blood pH, temperature, glucose, heart rate, PaO2 , and WBC, relatively. Small changes in measured values correlated with several-fold mortality rate increases. However, high mortality rates and abrupt mortality increases were often hidden by the common practice of thresholding or binning physiological parameters. The best predictors of in-hospital mortality were blood pH, temperature, and FiO2 (scaled Brier scores: 0.084, 0.063, and 0.049, respectively). Conclusions: In-hospital mortality is high and sharply increasing at extremes of blood pH, body temperature, and other parameters. Common-practice thresholding obscures these associations. In practice, vital signs are sometimes treated more casually than laboratory-tested parameters. Yet, vitals are easier to obtain and we found they are often the best mortality predictors, supporting perspectives that vitals are undervalued.
Case Reports
Neurology
Myoclonic status epilepticus after severe hyperthermia in a patient with coronavirus disease 2019
Katherine A Hill, John J Peters, Sara M Schaefer
Acute Crit Care. 2023;38(4):509-512.   Published online March 24, 2022
DOI: https://doi.org/10.4266/acc.2021.01452
  • 2,644 View
  • 80 Download
AbstractAbstract PDF
Myoclonic status epilepticus (MSE) is a sign of severe neurologic injury in cardiac arrest patients. To our knowledge, MSE has not been described as a result of prolonged hyperpyrexia. A 56-yearold man with coronavirus disease 2019 presented with acute respiratory distress syndrome, septic/hypovolemic shock, and presumed community-acquired pneumonia. Five days after presentation, he developed a sustained fever of 42.1°C that did not respond to acetaminophen or ice water gastric lavage. After several hours, he was placed on surface cooling. Three hours after fever resolution, new multifocal myoclonus was noted in the patient’s arms and trunk. Electroencephalography showed midline spikes consistent with MSE, which resolved with 40 mg/kg of levetiracetam. This case demonstrates that severe hyperthermia can cause cortical injury significant enough to trigger MSE and should be treated emergently using the most aggressive measures available. Providers should have a low threshold for electroencephalography in intubated patients with a recent history of hyperpyrexia.
Neurology
Malignant Syndrome in Parkinson Disease Similar to Severe Infection
Dong Hun Lee, Jeong Mi Moon, Yong Soo Cho
Korean J Crit Care Med. 2017;32(4):359-362.   Published online December 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00087
  • 16,647 View
  • 203 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
A 70-year-old woman with Parkinson disease was admitted to the emergency department with altered consciousness, fever and convulsive movements without experiencing withdrawal from antiparkinsonian medication. Six hours after the emergency department visit, the patient had a hyperpyrexia (>40°C) and a systolic blood pressure of 40 mmHg. There was no evidence of bacterial infection based on extensive workups. The patient was discharged without aggravation of Parkinson disease symptoms after treatment that included administration of dantrolene sodium, enforcement of continuous renal replacement therapy and cooling blankets. Malignant syndrome should be suspected if high fever occurs in Parkinson disease patients without evidence of a definitive infection.

Citations

Citations to this article as recorded by  
  • Parkinsonism-Hyperpyrexia Syndrome and Dyskinesia-Hyperpyrexia Syndrome in Parkinson’s Disease: Two Cases and Literature Review
    Jian-Yong Wang, Jie-Fan Huang, Shi-Guo Zhu, Shi-Shi Huang, Rong-Pei Liu, Bei-Lei Hu, Jian-Hong Zhu, Xiong Zhang
    Journal of Parkinson's Disease.2022; 12(6): 1727.     CrossRef
Review
Hematology
Severe Fever with Thrombocytopenia Syndrome
Seung Jin Yoo, Sang Taek Heo, Keun Hwa Lee
Korean J Crit Care Med. 2014;29(2):59-63.   Published online May 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.2.59
  • 5,463 View
  • 89 Download
  • 3 Crossref
AbstractAbstract PDF
Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease, caused by a novel species of Phlebovirus of Bunyaviridae family, in China, South Korea, and Japan. SFTS is primarily known as a tick-borne disease, and human-to-human transmission is also possible in contact with infectious blood. Common clinical manifestations include fever, thrombocytopenia, and leukopenia as initial symptoms, and multiple organ dysfunction and failure manifest with disease progression. Whereas disease mortality is reported to be 12% to 30% in China, a recent report of cumulative SFTS cases indicated 47% in Korea. Risk factors associated with SFTS were age, presence of neurologic disturbance, serum enzyme levels, and elevated concentrations of certain cytokines. Diagnosis of SFTS is based on viral isolation, viral identification by polymerase chain reaction, and serologic identification of specific immunoglobulin G. Therapeutic guideline has not been formulated, but conservative management is the mainstream of treatment to prevent disease progression and fatal complications.

Citations

Citations to this article as recorded by  
  • The first discovery of severe fever with thrombocytopenia syndrome virus in Taiwan
    Tsai-Lu Lin, Shan-Chia Ou, Ken Maeda, Hiroshi Shimoda, Jacky Peng-Wen Chan, Wu-Chun Tu, Wei-Li Hsu, Chi-Chung Chou
    Emerging Microbes & Infections.2020; 9(1): 148.     CrossRef
  • Epidemiology of severe fever and thrombocytopenia syndrome virus infection and the need for therapeutics for the prevention
    Norbert John C. Robles, Hae Jung Han, Su-Jin Park, Young Ki Choi
    Clinical and Experimental Vaccine Research.2018; 7(1): 43.     CrossRef
  • Two Treatment Cases of Severe Fever and Thrombocytopenia Syndrome with Oral Ribavirin and Plasma Exchange
    In Park, Hye In Kim, Ki Tae Kwon
    Infection & Chemotherapy.2017; 49(1): 72.     CrossRef
Original Article
Causes of Fever in the ICU - A Prospective, Cohort Study
Eun Ju Jeon, Hye Min Lee, Sung Gun Cho, Hyung Koo Kang, Hee Won Kwak, Ju Han Song, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim
Korean J Crit Care Med. 2008;23(1):13-17.
DOI: https://doi.org/10.4266/kjccm.2008.23.1.13
  • 3,126 View
  • 36 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Fever develops in 70% of ICU patients. In the present study, we tried to figure out causes of fever and the prognosis of febrile patients in the ICU in a prospective, cohort method.
METHODS
From February to June 2007, patients admitted to medical ICU were daily screened and those who developed fever were enrolled. 237 consecutive admissions of 237 patients over a 5-month period were analyzed. Clinical parameters, including demographic data, underlying diseases, duration of ICU stay, causes of fever and final outcome were analyzed.
RESULTS
Fever (core temperature > or =38.3degrees C) was present in 8% of admission, and it was caused by infective (84.2%) and non-infective processes (15.8%). Most fever occurred within first 5 days in the course of the admission (68.4%) and most lasted less than 5 days (57.9%). The median Acute Physiology and Chronic Health Evaluation (APACHE) III score at the time of fever was 43 (+/-19). Those with infectious fever had no significant differences in terms of severity of diseases in comparison with those with non-infectious cause of fever. The most common cause of infective fever was pneumonia (n=11). Prolonged fever (> or =5 days), all of which was caused by infection, occurred in 11 patients. Those with prolonged fever had higher mortality rate than short duration of fever (37.5% vs 0%, p<0.05).
CONCLUSION
Infection, especially pneumonia is common cause of fever in the ICU. Prolonged fever is associated with high mortality rate.

Citations

Citations to this article as recorded by  
  • The Value of Procalcitonin and the SAPS II and APACHE III Scores in the Differentiation of Infectious and Non-infectious Fever in the ICU: A Prospective, Cohort Study
    Eun Ju Jeon, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Ae Ja Park, Jae Yeol Kim
    Journal of Korean Medical Science.2010; 25(11): 1633.     CrossRef

ACC : Acute and Critical Care