Dr. Priyank Jha (General Practice) needs a second opinion on this medical case.
Systemic inflammation that accompanies acute respiratory distress syndrome in COVID-19 is associated with a high mortality rate, as high as 32.5%. Treatment options for severe cases remain limited.
The high mortality rate, lack of effective therapies, and extremely high volume of cases have led to a clear need for reliable prognostic markers to indicate which patients are at the highest risk of death and thus require closer monitoring.
One factor that is common to the majority of hospitalized COVID-19 patients is fever. The degree of temperature elevation might reflect the severity of inflammation. However, there are currently no published studies that have looked at body temperature (BT) as a potential prognostic marker.
We sought to analyze how BT monitoring might inform mortality rate estimates in COVID-19-positive patients.
Our results indicate that only half of the patients with positive SARS-CoV-2 virus present with BT > 37 °C at the initial presentation. However, temperature elevation is common, and high maximum temperature during the course of SARS-CoV-2 infection was a significant harbinger of poor outcomes. In fact, one in three patients reaching a maximum BT above 39.5 °C died.
This was approximately a 5-fold increase in mortality rate as compared to patients whose temperature never broke 37 °C. In contrast, almost half of the patients initially presenting with low BT (< 35.5 °C) died. Our results, therefore, suggest that poor BT control during the COVID 19 disease course is a marker of poor prognosis and BT can be used as an easily obtained prognostic indicator.
It remains unknown if controlling the high temperature in severely ill COVID-19 patients would alleviate inflammatory response and improve their outcome. Future studies are necessary to address this question.
We acknowledge the limitations of our study including unknown methods of temperature measurement, lack of follow-up of temperature in patients without hospital admission, and that the data is not adjusted for potential confounding factors.
Nevertheless, a clear trend in increased mortality among the patients with poor temperature control highlights the usefulness of this non-invasively and easily obtained parameter for evaluating patients’ prognoses.