Fever in a palliative care setting: Clinical insights and implications from a prospective observational cohort study

Background: Fever is a frequent but complex symptom in adults with a limited prognosis, arising from multifactorial causes beyond infection. Despite its impact on symptom burden and therapeutic decision-making, evidence from inpatient palliative care settings is limited. Aim: To assess the prevalence, characteristics, and associated factors of fever in adults with a limited prognosis receiving inpatient hospice palliative care in order to enhance understanding of this symptom in palliative care settings. Design: Prospective observational cohort study. Collected data included demographic and clinical variables, symptom burden, potential risk factors for infections (such as presence of medical devices and pressure injuries), and fever occurrence. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of fever. Setting/participants: The study was conducted in an inpatient hospice palliative care unit within the Luigi Sacco Hospital in Milan, Italy (January and December 2024). A total of 145 adults with a limited prognosis were enrolled. Results: Fever occurred in 40% of patients, with a median onset of 5.5 days after admission. In 39.7% of cases, fever was attributed to infections, mainly catheter-associated urinary tract infection. Medical devices, particularly bladder catheters (89.7%), were strongly associated with fever (adjusted odds ratio: 12.42; confidence interval: 2.39–64.57). Conclusions: Fever is common among adults receiving inpatient hospice palliative care and is infection-related in about 40% of cases. Its strong association with medical devices highlights the need for proportional, personalised interventions that primarily consider prognosis, symptom relief, and quality of life. Registration: ClinicalTrials.gov ID NCT07106073.