The goal of this observational study is to evaluate the frequency and characteristics of fever in terminally ill adult patients admitted to the Infectious Diseases Hospice at Luigi Sacco Hospital in Milan. The main questions it aims to answer are:

• How often does fever occur in terminally ill patients during hospice care?
• What are the typical features of fever in this population in terms of intensity, duration, possible causes, and treatment strategies?
• Is there any correlation between the occurrence of fever and patients' clinical characteristics, such as age, sex, BMI, comorbidities, and palliative prognostic scores (PPS and PPI)?

Participants will be adult patients (≥18 years) with a life expectancy of more than 24 hours and less than 3 months.

During their stay, the following data will be collected:

• Presence and characteristics of fever (temperature, duration, treatment, suspected cause)
• Clinical and demographic information (e.g., age, sex, BMI, comorbidities, performance status)
• Details on hospitalization (e.g., symptom burden, need for palliative sedation, outcome)

The study will enroll approximately 250 patients consecutively over a 48-week period. No additional procedures or treatments beyond standard clinical care will be required.

Fever is a common clinical finding in palliative care, but its prevalence, causes, and management in terminally ill patients remain poorly documented. Existing studies report highly variable frequencies of fever near the end of life, ranging from 3% to 24%, depending on the population and setting. In this context, understanding the patterns and implications of fever in hospice patients is critical to improve symptom management and guide clinical decision-making.

This prospective, non-profit, single-center cohort study aims to collect real-world data on the presence of fever in a terminal population admitted to the Infectious Diseases Hospice at Luigi Sacco Hospital in Milan. The study will prospectively collect clinical, demographic, and treatment-related variables over a continuous 48-week period, without any deviation from routine clinical practice. By examining associations with prognostic indices, comorbidities, and symptom burden, the study also seeks to clarify whether fever represents a relevant marker of disease trajectory or end-of-life decline.

Data will be analyzed in aggregated, de-identified form using both descriptive and inferential statistics. This study is expected to contribute to filling a knowledge gap in palliative care literature and may help develop evidence-based guidance for the diagnostic and therapeutic management of fever in hospice settings.

Inclusion Criteria:

• Male and female patients;
• Age ≥ 18 years;
• Terminally ill patients with an estimated life expectancy between 24 hours and 3 months;
• Signed informed consent.

Exclusion Criteria:

• Patients under 18 years of age;
• Terminally ill patients with a life expectancy < 24 hours
• Non-terminal patients admitted for respite care.

Patients will be recruited from the Hospice of Infectious Diseases at Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy. The study population includes adult terminally ill patients admitted for end-of-life care.