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Fever is associated with higher morbidity and clot burden in patients with acute pulmonary embolism
  1. Muhammad Saad1,2,
  2. Danial H Shaikh1,2,
  3. Nikhitha Mantri1,2,
  4. Ahmed Alemam1,2,
  5. Aiyi Zhang1,2 and
  6. Muhammad Adrish1,2
  1. 1 Department of Internal Medicine, BronxCare Health System, Bronx, New York, USA
  2. 2 Department of Medicine, Affiliated with Icahn School of Medicine at Mt Sinai, New York, USA
  1. Correspondence to Dr Muhammad Adrish; aadrish{at}


Background Fever is considered as a presenting symptom of pulmonary embolism (PE). We aim to evaluate the association between PE and fever, its clinical characteristics, outcomes and role in prognosis.

Methods A retrospective chart review of patients who were hospitalised with the diagnosis of acute PE was conducted. Patients in whom underlying fever could also be attributable to an underlying infection were also excluded.

Results A total of 241 patients met the study criteria. 63 patients (25.7%) had fever within 1 week of diagnosis of PE of which four patients had fever that could be due to underlying infection and were excluded. Patients in PE with fever group were younger compared with PE without fever group (52.52 vs 58.68, p=0.012) and had higher incidence of smoking (44.1% vs 20.9%, p<0.001). Patients in PE with fever group were more likely to require intensive care admission (69.5% vs 35.7%, p<0.001), had a longer hospital length of stay (19.80 vs 12.20, p<0.001) and higher requirement of mechanical ventilation (30.5% vs 6.6%, p<0.001) compared with those without fever. PE with fever group were more likely to have massive and submassive PE (55.9% vs 36.8%, p=0.015) and had higher incidence of deep vein thrombosis (33.3% vs 17.4%, p=0.0347) compared with PE without fever. In a univariate model, there was higher likelihood of in-hospital mortality in PE with fever group compared with PE without fever (22.0% vs 10.4%, p=0.039).

Conclusion Patients with acute PE and fever have higher morbidity and clot burden.

  • pulmonary embolism
  • fever

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  • Contributors MS, MA and AZ wrote the first draft of the manuscript and reviewed the data for its integrity. DHS, AA, NM, MS and MA did the data collection. AZ performed the statistical analysis for the study. All authors reviewed, edited and approved the final draft of this manuscript. MA is guarantor of this paper and take full responsibility for the integrity of the work as a whole, from inception to publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval BronxCare Hospital Center, IRB#01111803.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data available upon request

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