Temperature Instability In Patients With Acute Myeloid Leukemia

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Patients with active leukemia are at high risk of infection due to profound marrow suppression. Fever in such patients constitutes a medical emergency and requires prompt and aggressive antimicrobial therapy. However, active leukemia is also a recognized cause of pyrexia per se. This complicates the interpretation of fever during active leukemia and may lead to overdiagnosis of infection. Here we provide the first description of the temperature pattern observed in patients with acute myeloid leukemia (AML). METHODS: A retrospective study was undertaken on patients admitted to Yale-New Haven Hospital between 2013-2018. Inclusion criteria included (i) active acute myeloid leukemia as defined by peripheral blood blast count >3% and confirmation of diagnosis by chart review; (ii) a comprehensive negative microbiological workup including blood culture, urine culture, and bronchoscopy with bronchoalveolar lavage; (iii) presence of fever (temperature >100.3 °F). Longitudinal temperature data was extracted from the electronic medical record and analyzed using the R software environment. Savitzky-Golay smoothing was used to approximate the patient’s baseline temperature. Temperature spikes and troughs were defined by temperature readings above and below the 80% prediction interval, respectively. RESULTS: 14 patients were found to have active AML, fever, and definitively negative infectious testing. Admissions were protracted, with a mean duration of 19 days. Average maximum blast percentage was 36.0%. The temperature curve in all patients was strikingly erratic, with spikes on average every 16.2 hours and troughs every 15.8 hours. The baseline temperature itself was also quite unstable as it undulated between an average maximum/minimum of 100.1 and 98.0 degrees. The amplitude of the fever curve was high, with an average maximum/minimum of 102.7 and 96.9 degrees (delta of 5.9 degrees). Finally, the fevers were highly persistent, with spikes occurring on an average of 82.8% of patient days. Even after comprehensive negative microbiological testing, patients remained on broad-spectrum antibiotics for an average of 16 days. CONCLUSIONS: Patients with active AML demonstrate prolonged temperature instability, with rapid oscillation between extreme hyperthermia and hypothermia, and marked undulations in baseline temperature for days to weeks. CLINICAL IMPLICATIONS: These unusual features should clue intensive care physicians to the possibility that fever in leukemic patients may reflect cancer activity rather than infection. Earlier recognition of this phenomenon may reduce hospital length of stay and unnecessary use of antibiotics. More generally, this study suggests the potential utility of temperature dynamics in discerning the etiology of fever. DISCLOSURES: No relevant relationships by Chace Avery, source=Web Response No relevant relationships by Avi Cohen, source=Web Response No relevant relationships by Charles Dela Cruz, source=Web Response No relevant relationships by Solmaz Ehteshami-Afshar, source=Web Response No relevant relationships by Samir Gautam, source=Web Response No relevant relationships by Peter Kahn, source=Web Response No relevant relationships by Seohyuk Lee, source=Web Response No relevant relationships by Derek Tsang, source=Web Response No relevant relationships by Patricia Valda-Toro, source=Web Response