title: The identification of risk factors for critically ill patients with acute fever and formulation of activation criteria to alert outpatient clinic doctors.
abstract: OBJECTIVE
  Acute fever is the most common early clinical symptom of many critical illnesses with a high mortality rate. It is necessary to identify patients with severe acute fever early and accurately. The aim of this study is to identify risk factors for critically ill outpatients with acute fever and formulate activation criteria of adult fever state score (AFSS) to alert outpatient clinic doctors.
  
  
  METHODS
  Retrospectively, 357 adult patients with acute fever were divided into two groups: 180 patients with a severe state and 177 patients with a mild state. Logistic regression was used to determine risk factors for the severe state. Risk factors were weighted and an AFSS was formulated. A receiver operating characteristic (ROC) analysis of weighted cumulative scores was performed to evaluate the diagnostic accuracy of AFSS, and the kappa test was used to confirm diagnostic reliability. A χ(2) -test for trend was applied to determine the relevance between AFSS and admission rate and in-hospital mortality. A Kruskal-Wallis test was used to examine the relationship between AFSS and length of stay.
  
  
  RESULTS
  Risk factors for state included: old age, long fever course, past medical history, abnormal temperature, abnormal respiratory rate, abnormal heart rate, abnormal mean arterial pressure and abnormal peripheral white blood cell count. The area under the ROC curve of AFSS was 0.964 and ≥8 points predicted severe state; the Kappa value was 0.801. With an increase in score, there was an increase in admission rate, mortality rate and length of stay. The forecast performance of AFSS was superior to the modified early warning score.
  
  
  CONCLUSIONS
  The AFSS has high diagnostic accuracy and reliability for the early identification of patients with severe acute fever.
authors.affiliation: Department of Infectious Disease and Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: Hongli
authors.initials: H
authors.lastname: Xiao
authors.forename: Haiyu
authors.initials: H
authors.lastname: Qi
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Li
authors.forename: Suxia
authors.initials: S
authors.lastname: Ma
authors.forename: Zongli
authors.initials: Z
authors.lastname: Diao
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Fangfang
authors.initials: F
authors.lastname: Sun
authors.forename: Chenghong
authors.initials: C
authors.lastname: Yin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D002681:China / Q000453:epidemiology; D003142:Communication; D016638:Critical Illness; D005260:Female; D005334:Fever / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D055815:Young Adult