Low-grade and high-grade fever at presentation of acute pulmonary embolism

Abstract

We retrospectively reviewed the medical records of 154 consecutive patients with acute pulmonary embolism (PE) admitted to an Internal Medicine Service. At presentation, fever (temperature > 37 degrees C) without other identified causes was present in 28 patients (18.2%): 27 patients had low-grade fever (temperature 37-39 degrees C) and one patient had high-grade fever (temperature > 39 degrees C). Epidemiological and clinical characteristics, electrocardiographic and chest radiograph abnormalities and mortality rate were similar in patients with and without fever. Fever, including high-grade fever, is a possible presenting feature in patients with acute PE. Patients with acute PE and fever have similar characteristics compared with those without fever.

Fever in pulmonary embolism

“…They suggested that since their patients with fever demonstrated more frequent hemoptysis, fever might result from infarction. Additionally, they found that more PE patients with fever demonstrated leukocytosis and thrombocytosis in comparison with PE without fever without reaching statistical significance [11]. In our study, PE patients with fever demonstrated LC similar to patients without fever.…”

“…Fever-associated PE has been reported as usually low grade but higher temperature has also been observed in various percentages including 0.6, 2, 7 and 25% [1,2,10,11]. In our study, fever accounted for 33% of the PE patients with fever, and 12% of them showed fever greater than 398C.…”

Age and sex-dependent trends in pulmonary embolism testing and derivation of a clinical decision rule for young patients

“…Tachycardia has been recognised as an important, if non-specific, predictor of PE and is included as a factor in PERC, the Geneva score and the Wells score, but our results indicate that tachycardia is not an independent predictor of PE in young patients. Conversely, association between PE and fever has been described,20 21 but previous non-age-stratified investigations have not found fever to have predictive value,22 and it is not included in any of the major risk stratification scores. Our results for older patients are concordant with this, but in younger patients fever is a highly significant predictor with OR >3.…”

Pulmonary Embolism and Fever

“…2,5 The presence of a slight inflammatory response is indirectly confirmed by the concomitant increase of serum markers of inflammation. 4,6 The presence of a modest leucocytosis (rarely exceedingly 20 000/mm 3 ) during the first hospital week is not uncommon, being described in up to 20% of patients with PE who have no other possible or defined cause of leucocytosis. 2,7 The differential white blood cell count usually remains normal, only rarely showing a slight neutrophilia.…”

“…7 Similarly, a slight increase in erythrocyte sedimentation rate and in C-reactive protein can also be observed. 4,8 True PE-related fever is not associated with the extension of vascular obstruction and does not have any prognostic role 4,6 ; its presence should not dissuade the clinician from diagnosing PE and initiating appropriate therapy. Furthermore, PE-related fever usually subsides after anticoagulant treatment, whereas the addition of antibiotics does not provide any additional benefit.…”