Abstract
Objective : Febrile episode is a common symptom presenting in various diseases. In elderly patients, it is difficult to determine the cause of fever at the initial stage, because these patients often showed the atypical clinical features. Therefore, we analyzed advanced elderly patients with febrile episodes to clarify the cause of fever retrospectively. Moreover, it was investigated whether there were differences in clinical conditions between patients with low-grade fever (<38°C) and those with high-grade fever (≥38°C).
Materials and Methods : The subjects were 107 advanced elderly patients aged 75 years or older who needed hospitalization due to fever after an initial visit to Geriatric Medicine, Juntendo Tokyo Koto Geriatric Medical Center, between June 2002 and September 2006. The subjects were divided into two groups; low-grade fever group (<38°C) and high-grade fever group (≥38°C). We examined the etiologies of febrile episode, white blood cells counts, ratio of neutrophils and CRP as inflammatory findings, and concentrations of total protein and albumin in serum.
Results : The etiologies of the febrile episodes were mainly due to respiratory infection and urinary tract infection. These diseases showed high values of inflammatory findings, however, there were no significant differences in inflammatory findings such as, white blood cell (WBC count, neutrophil ratio, and CRP value between two groups. Patients with pneumonia showed the highest values of inflammatory findings.
Conclusions : It is important to be aware that respiratory and urinary tract infections often cause febrile episodes in advanced elderly people and investigate these possibilities at the initial stage. It might be useful to measure the neutrophil ratio and CRP values to detect infectious diseases. However, the severity of the initial fever does not relate to clinical situations in the elderly patients with febrile episodes. On the contrary, it is suggested that death of patients in the low-grade fever group occurs more commonly than that in the high-grade fever group.
