Utility of admission biomarkers in predicting severe outcomes and triage in acute febrile illness: A cohort study

Objectives: To determine the role of biomarkers in acute febrile illness patients at admission in predicting moderate-to-severe multiorgan dysfunction at 24 h of hospitalization and the need for invasive mechanical ventilation at 48 h of hospitalization. Methods: This prospective cohort study was conducted among 100 acute febrile illness patients brought to the emergency department. Biochemical and clinical parameters at hospital admission were recorded. The highest Sequential Organ Failure Assessment score was calculated at 24 h of hospitalization. The need for invasive mechanical ventilation at 48 h of hospitalization was evaluated. Results: Of the 95 acute febrile illness patients, 60 (63.15%) had moderate-to-severe multiorgan dysfunction. Multivariable logistic regression showed that admission aspartate aminotransferase level ≥89 U/L (P < 0.001; area under the curve, 0.752), C-reactive protein level ≥161 mg/dL (P < 0.001; area under the curve, 0.751), and urea level ≥74 mg/dL (P < 0.001; area under the curve, 0.855) were independent predictors of moderate-to-severe multiorgan dysfunction at 24 h. Serum interleukin-6 level ≥84.48 pg/mL (P = 0.002; area under the curve, 0.728) on admission was an independent predictor of the need for invasive mechanical ventilation. Conclusions: Urea, aspartate aminotransferase, and C-reactive protein levels on admission may independently predict moderate-to-severe multiorgan dysfunction in acute febrile illness patients at 24 h of hospitalization. In addition, interleukin-6 level may be an independent predictor of the need for invasive mechanical ventilation at 48 h of hospitalization.