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Fever Patterns, Cytokine Profiles, and Outcomes in COVID-19

2020; Oxford University Press; Volume: 7; Issue: 9 Linguagem: Inglês

10.1093/ofid/ofaa375

2328-8957

Deborah H. L. Ng, Chiaw Yee Choy, Yi‐Hao Chan, Barnaby Edward Young, Siew‐Wai Fong, Lisa F. P. Ng, Laurent Rénia, David Chien Lye, Po Ying Chia, Angela Chow Li Ping, Brenda Ang, Chen Seong Wong, Cheng Chuan Lee, Ding Ying, Jun-Yang Tay, Kalisvar Marimuthu, Lawrence S. Lee, Yee‐Sin Leo, Li Min Ling, Ang Li, Lin Cui, Mark Chen, Mónica Chan, Sharavan Sadasiv Mucheli, Oon‐Tek Ng, Pei Hua Lee, Poh Lian Lim, Sapna Sadarangani, Shawn Vasoo, Stephanie Sutjipto, Tsin Wen Yeo, Tze Minn Mak,

COVID-19 epidemiological studies

Abstract Background Prolonged fever is associated with adverse outcomes in dengue viral infection. Similar fever patterns are observed in COVID-19 with unclear significance. Methods We conducted a hospital-based case–control study of patients admitted for COVID-19 with prolonged fever (fever >7 days) and saddleback fever (recurrence of fever, lasting <24 hours, after defervescence beyond day 7 of illness). Fever was defined as a temperature of ≥38.0°C. Cytokines were determined with multiplex microbead-based immunoassay for a subgroup of patients. Adverse outcomes were hypoxia, intensive care unit (ICU) admission, mechanical ventilation, and mortality. Results A total of 142 patients were included in the study; 12.7% (18/142) of cases had prolonged fever, and 9.9% (14/142) had saddleback fever. Those with prolonged fever had a median duration of fever (interquartile range [IQR]) of 10 (9–11) days for prolonged fever cases, while fever recurred at a median (IQR) of 10 (8–12) days for those with saddleback fever. Both prolonged (27.8% vs 0.9%; P < .01) and saddleback fever (14.3% vs 0.9%; P = .03) were associated with hypoxia compared with controls. Cases with prolonged fever were also more likely to require ICU admission compared with controls (11.1% vs 0.9%; P = .05). Patients with prolonged fever had higher induced protein–10 and lower interleukin-1α levels compared with those with saddleback fever at the early acute phase of disease. Conclusions Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. Patients with saddleback fever appeared to have good outcomes regardless of the fever.