Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis.

Yue Hu,Derong Cui,Xintao Wang,Yong Guo,Yi Li,Dawei Sun

doi:10.3389/fmed.2020.00086

Abstract

Objective: The aim of this research was to study the factors contributing to the survival rate of in-hospital cardiac arrest (IHCA) and to determine whether the incidence density of fever (IDF) acts as a mediator.Methods: Data from patients with IHCA who survived more than 48 h were collected from 2011 to 2017. IDF was defined as the fever duration divided by the hospitalization duration, prolonged fever was defined as fever lasting for more than 5 days, and early fever was defined as an initial onset within the first 2 days of IHCA. Possible clinical variables associated with IDF were examined by linear regression, and possible clinical variables associated with survival rate were examined by univariate and multivariate analyses. IDF was investigated as a mediator of the indirect effects of the risk factors on survival.Results: In our retrospective study, the median IDF was 0, with an interquartile range from 0 to 0.42. Prolonged fever was noted in 16% (97/605) of the total, and early fever was noted in 17.2% (104/605) of the total. Linear regression results showed that positive chest X-ray, central venous catheter and Glasgow Coma Score (GCS) ≤ 8 were related to IDF. The IDF (OR: 0.36, 95% CI, 0.13–0.97, P = 0.04), prolonged fever (adjusted OR = 0.13, 95% CI, 0.06–0.29, P < 0.001), positive chest X-ray (OR: 0.67, 95% CI, 0.46–0.98, P = 0.04), central venous catheter placement (OR: 0.54, 95% CI, 0.34–0.89, P = 0.01), and endotracheal intubation (OR: 0.47, 95% CI, 0.33–0.69, P < 0.001) were also related to the negative outcome of hospital discharge after adjustment. Additionally, positive chest X-ray had a 19% effect on survival outcome through IDF as a mediator, and the indirect effect of central venous catheter mediated by IDF accounted for 10% of the total.Conclusions: A higher IDF, prolonged fever, a positive chest X-ray, the use of a central venous catheter and endotracheal intubation reduced the survival rate of these patients, and the detrimental impacts of a positive chest X-ray and the use of a central venous catheter on survival outcomes were partially mediated by IDF.

Highlights

In-hospital cardiac arrest (IHCA) is the leading cause of morbidity and mortality worldwide
Clinical Characteristics of the Study Population. In this retrospective cohort study, a total of 2,427 patients suffered from IHCA and return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation, of whom 605 were eligible for inclusion in our study
Our results showed that positive chest X-ray (Beta = 0.07, 95% CI, 0.02–0.12, P = 0.008), central venous catheter (Beta = 0.06, 95% CI, 0.003–0.123, P = 0.04), Glasgow Coma Scale (GCS) ≤ 8 (Beta = 0.20, 95% CI, 0.12– 0.29, P < 0.001), and IHCA in the emergency ward (Beta = 0.11, 95% CI, 0.04–0.23, P = 0.008) were significant factors related to Incidence Density of Fever (IDF) (Table 2)

Summary

Introduction

In-hospital cardiac arrest (IHCA) is the leading cause of morbidity and mortality worldwide. Despite the return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation, those who experience IHCA are still vulnerable to mortality and morbidity. Timely and effective postresuscitation care can improve the survival rate among these weak patients [3]. One of the primary challenges facing postresuscitation care is fever control. Known as hyperthermia, has a high incidence among patients resuscitated from IHCA [4]. Both clinical and experimental evidence have demonstrated that fever in the early stage after ROSC is independently associated with increased morbidity and mortality due to IHCA [5,6,7,8,9,10]. Clinical symptoms prior to the occurrence of fever are common, and early intervention can prevent the progression of fever [13]

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Results

Conclusion