Abstract WP371: Characteristics of Fever in Intracerebral Hemorrhage

Abstract

Introduction: Fever in intracerebral hemorrhage (ICH) patients can be due to infectious or noninfectious etiology, including central mechanisms. We sought to compare patients with ICH and infectious fever to those with noninfectious fever. Methods: Among 351 consecutive primary ICH patients admitted to our institution from April 2009 to March 2010, 136 (39%) developed fever. Fever was defined as temperature > 100.9°F during hospitalization. Cases were reviewed to determine if the patient had fever due to infectious versus noninfectious etiology. The diagnosis of infection was based on results of microbial cultures and National Healthcare Safety Network criteria. Other data collected included age, sex, maximum temperature (Tmax), medical history, ICH location, intraventricular hemorrhage (IVH), ICH volume as measured by standard ABC/2 bedside calculation, external ventricular drain (EVD) placement, surgical evacuation, length of stay (LOS), and inpatient mortality. Univariate analysis and multivariable logistic regression model were used to determine characteristics associated with infection status. Results: Among the 136 ICH patients with fever, 96 (71%) had noninfectious fever and 40 (29%) had infectious fever. In the univariate analysis, patients with infectious fever did not differ from patients with noninfectious fever with respect to age (61.3 vs 60.1 years, p 0.6), female sex (40% vs 48%, p 0.8), Tmax (102.2 vs 102.2°F, p 0.96), IVH (60% vs 71%, p 0.23), ICH volume (42 vs 40 cc, p 0.8), EVD placement (48% vs 51%, p 0.85), or surgical evacuation (30% vs 29%, p 1.0). Infectious fever was significantly associated with higher LOS (18.2 vs 11.1 days, p <0.001), and this remained significant in survivors (18.6 vs 14.2 days, p 0.01). Noninfectious fever was associated with significantly higher inpatient mortality (35% vs 8%, p 0.0006). In multivariate analysis, infectious fever significantly correlated with prolonged LOS in survivors when dichotomized using a median of 15 days (OR 5.37, p 0.003). Conclusions: Patients with ICH who develop fever associated with an infectious etiology have longer LOS but lower in-hospital mortality. Further studies are warranted to understand fever in ICH patients.