Fever in liver transplant recipients in the intensive care unit

Whether febrile illnesses in the intensive care unit (ICU) have unique spec trum, etiologies, and outcome has not been determined in liver transplant r ecipients. We studied 78 consecutive febrile patients over a 4-yr period; 4 9% (38/78) were in the ECU and 51% (40/78) were in the non-ICU setting. Of febrile patients in the ICU, 87% (33/38) had infection and 13% had non-infe ctious etiology for fever. Seventy-nine percent (26/33) of the infections a ssociated with fever in the ICU were bacterial, 9% (3/33) were viral, and 9 % (3/33) were fungal in etiology. Pneumonia (30%), catheter-related bactere mia (15%), and biliary tree (9%) were the predominant sources of infections associated with fever in the ICU. Bacteremia was documented in 45% of the patients with fever in the ICU. Fifty-three percent (20/38) of the febrile episodes in the ICU occurred during the initial post-transplant stay, and 4 7% (18/38) during a subsequent readmission. Pneumonia accounted for 41% of all febrile infections during the first 7 d of ICU stay, but only 14% of th ose after 7 d. Febrile patients in the ICU had higher APACHE II scores (p = 0.001), higher APS scores (p = 0.0001), higher bilirubin (p = 0.001), lowe r cholesterol (p = 0.019), higher prothrombin time (p = 0.001), were more t achycardiac (p = 0.002), and were more likely to have abnormal blood pressu re (p = 0.001) than those in the non-ICU setting. Twenty-three percent of a ll infections in the ICU were unaccompanied by fever and 9% were accompanie d by hypothermia. Mortality at 14 d (24 versus 0%, p = 0.001) and at 30 d ( 34 versus 5%, p = 0.001) was significantly higher in febrile patients in th e ICU, as compared to the patients in the non-ICU setting. These data have implications for diagnostic evaluation and management of critically ill feb rile liver transplant recipients.