Clinical Profile Of Fever In The Geriatric Patients Admitted In Icu-A One Year Hospital Based Cross Sectional Study

Abstract

Background: Geriatric population is the population whose age falls above 60 years. It forms 11.5% of the total 7 billion population in the world. Fever in geriatric population predisposes to higher morbidity, mortality. Atypical and typical, both patterns of fever are seen in geriatric patients. Sepsis is an vital factor which leads to increased morbidity, mortality in geriatric patients. Studies regarding fever in geriatric patients admitted in ICU are less. Managing the geriatric patients is challenging. Severe sepsis is more frequent in geriatric population and associated with increased morbidity, mortality. Timely management is required for better outcomes in these patients. Therefore, further studies on the geriatric patients will help to decide appropriate management in future. Objectives: 1. To study the clinical profile of fever in the geriatric patients admitted in ICU. 2. To study the etiologies of fever in the geriatric patients admitted in ICU. Methodology: This study was a one year hospital based cross sectional study which comprised of 100 patients. The study included geriatric patients who presented with fever and admitted in ICU or those who developed fever after admission. A detailed history was taken and local, systemic examination was carried out. The relevant investigations were done and the data was collected using a proforma meeting the objectives of the study. The clinical profile of fever in the geriatric patients admitted in ICU was studied. Results: The study included a total of 100 geriatric patients admitted in ICU with fever or later developing fever. Out of the total 100 patients, 62(62%) were males and 38(38%) were females. The mean age was 70.27 years. 53(53%) patients were in 60-69 years group, 31(31%) were seen in 70-79 years group and 16(16%) were above or equal to 80 years. In the duration of stay, a total number of 46(46%) patients were in the 1-5 days group, 32(32%) were in the 6-10 days group, 14(14%) were in the 11-15 days group and 8(8%) were in the 16 days or more group. The mean duration of stay was 7.30 days. All patients had fever. Dyspnoea was the commonest symptom after fever and was seen in 27(27%) patients. This was followed by cough, seen in 18(18%) patients. The commonest cause of fever was pneumonia(36%), followed by UTI(26%), cellulitis(7%), viral fever(5%) and others. Only 6(6%) patients developed fever after admission. The causes included Pneumonia(4%) and Bedsores(2%). Tachycardia was seen in 82(82%) patients. Hypotension was seen in 30(30%) patients, Tachypnoea in 36% patients. Out of 100 patients, 31(31%) patients died and 69(69%) patients were discharged. The most common cause of mortality was pneumonia (17%). UTI was the next common cause seen in 7(7%) patients. The commonest co-morbidity was Diabetes mellitus(51%). Next was hypertension (35%), IHD (6%), hypothyroidism(4%), Alcoholic(1%), PVD(1%). The most common complication was sepsis seen in 40(40%) patients. This was followed by AKI (36%), shock (30%), ventilatory support (18%). Anaemia was seen in 52% patients. TLC were raised in 78% patients. Thrombocytopenia was detected in 41% patients. ESR, CRP were raised in 57% and 52% patients respectively. In renal tests, urea was raised in 63% patients and creatinine was increased in 73% patients. In LFTs, total bilirubin was raised in 25% patients. SGOT, SGPT were raised in 57% and 32% patients respectively. Hypoalbuminemia was seen in 67% patients. Serum procalcitonin was raised in 77% patients. Out of 36(36%) patients with pneumonia, bacterial pneumonia was seen in 27(75%) and viral pneumonia was seen in 9(25%) patients. Urine was normal in 75(75%) patients. 25(25%) patients showed increased WBCs in urine. No blood culture growth was seen in 80% patients. Among the blood culture positive patients(20%), the commonest organism was E.coli which was isolated in 8(8%) patients. Next was Klebsiella which was isolated in 3(3%) patients. 79(79%) patients showed normal findings in the USG. Among the abnormal USG(21%), the commonest abnormality seen was cystitis in 11(11%) patients. There was no growth in 69% patients. Among the urine culture positive patients(21%), the commonest organism was staphylococcus which was seen in 20(20%) patients. This was followed by E.coli(6%), Enterococcus(2%), Klebsiella(2%), Acinetobacter(1%). In pus culture, Staphylococcus was the most frequent organism which was present in 3(3%) patients and in sputum culture, Enterococcus was seen in 3(3%). Interpretation and Conclusion: Based on the findings of this study, the most cause of fever in the geriatric patients admitted in ICU was pneumonia followed by UTI. Other causes should also be considered in geriatric patients. Mortality was seen in 31% patients. The mean duration of stay was 7.30 days. The commonest etiology of death was pneumonia. The most common co-morbidities seen were Diabetes mellitus followed by hypertension. The complications seen were sepsis, AKI, shock. In pneumonia, bacterial cause was more common than viral. Sepsis was seen in 40% patients and serum procalcitonin was raised in 77%. Serum procalcitonin is an early marker of sepsis. Blood culture showed Staphylococcus as the commonest organism isolated. Urine culture showed E.coli.