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. 2020 Mar 25;7:86.
doi: 10.3389/fmed.2020.00086. eCollection 2020.

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

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Free PMC article

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

Yue Hu et al. Front Med (Lausanne). .
Free PMC article

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.

Keywords: cardiac arrest; causal mediation analysis; fever; mediator; survival rate.

Figures

Figure 1
Figure 1
Flow chart for patient inclusion in the study. ROSC, return of spontaneous circulation.
Figure 2
Figure 2
Direct, indirect, and total effect of positive chest X-ray on the survival rate mediated by the IDF. The solid line represents the positive chest X-ray, and the dashed line represents the negative chest X-ray. ACME, average causal mediation effect; ADE, average direct effect; IDF, incidence density of fever.
Figure 3
Figure 3
Direct, indirect, and total effects of central venous catheters on the survival rate mediated by the IDF. The solid line represents the patients who underwent central venous catheter, and the dashed line represents the patients without central venous catheter. ACME, average causal mediation effect; ADE, average direct effect; IDF, incidence density of fever.
Figure 4
Figure 4
Direct, indirect, and total effects of endotracheal intubation on the survival rate mediated by the IDF. The solid line represents patients who underwent endotracheal intubation, and the dashed line represents patients without endotracheal intubation. ACME, average causal mediation effect; ADE, average direct effect; IDF, incidence density of fever.

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