Prolonged fever identifies patients at risk for adverse COVID-19 outcomes
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Prolonged fever lasting more than 7 days after illness onset can help physicians identify patients at high risk for adverse outcomes from COVID-19, according to a study.
The analysis, which was published in Open Forum Infectious Diseases, also showed that patients with saddleback fever had favorable outcomes despite their fever.
“In patients with prolonged fever, close monitoring for deterioration should be instituted, while patients with saddleback fever who remain well and do not require supplemental oxygenation are unlikely to require close monitoring in hospital,” Deborah HL Ng, of the National Centre for Infectious Diseases and Tan Tock Seng Hospital’s department of infectious diseases in Singapore, and colleagues wrote. “In addition, as these patients with saddleback fever tend to do well, there is also no need for repeat laboratory testing or [chest X-ray], as the results are unlikely to change management or clinical outcomes.”
Ng and colleagues performed a hospital-based, case-control analysis of 142 patients with COVID-19. Of these patients, 12.7% had prolonged fever, which they defined as a fever lasting more than 7 days, and 9.9% had saddleback fever, defined as a recurrence of fever lasting less than a day after defervescence beyond day 7 of illness. The researchers defined fever as a body temperature of 38°C (100.4°F) or higher, and measured cytokines using a multiplex microbead-based immunoassay.
According to the researchers, patients with prolonged fever had a median fever duration of 10 days, and patients with saddleback fever had fever recurrence at a median of 10 days. Saddleback (14.3% vs. 0.9%; P = .03) and prolonged (27.8% vs. 0.9%; P = .01) fever were both associated with hypoxia compared with controls. Additionally, patients with prolonged fever had a higher likelihood of needing ICU admission compared with the control group (11.1% vs. 0.9%; P = .05).
Ng and colleagues noted that patients with prolonged fever had higher levels of interferon gamma-induced protein 10 and lower levels of interleukin 1 alpha — both cytokines — compared with patients with saddleback fever during the early acute phase of COVID-19 disease.
“The results of this study can be used to optimize placement of patients with COVID-19,” the researchers wrote. “Home or community isolation facilities and the other iterations for positive cases are commonly used globally to isolate positive patients. Such facilities free up hospital beds to enable sicker patients to be optimally managed.”
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