Antihyperthermic Treatment in the Management of Malignant Infarction of the Middle Cerebral Artery

Abstract

Malignant infarction of the middle cerebral artery (m-MCA) is a complication of ischemic stroke. Since hyperthermia is a predictor of poor outcome, and antihyperthermic treatment is well tolerated, our main aim was to analyze whether the systemic temperature decrease within the first 24 h was associated with a better outcome. Furthermore, we studied potential biochemical and neuroimaging biomarkers. This is a retrospective observational analysis that included 119 patients. The temperature variations within the first 24 h were recorded. Biochemical laboratory parameters and neuroimaging variables were also analyzed. The temperature increase at the first 24 h (OR: 158.97; CI 95%: 7.29–3465.61; p < 0.001) was independently associated with a higher mortality. Moreover, antihyperthermic treatment (OR: 0.08; CI 95%: 0.02–0.38; p = 0.002) was significantly associated with a good outcome at 3 months. Importantly, antihyperthermic treatment was associated with higher survival at 3 months (78% vs. 50%, p = 0.003). Significant independently associations between the development of m-MCA and both microalbuminuria (OR: 1.01; CI 95%: 1.00–1.02; p = 0.005) and leukoaraiosis (OR: 3.07; CI 1.84–5.13–1.02; p < 0.0001) were observed. Thus, antihyperthermic treatment within the first 24 h was associated with both a better outcome and higher survival. An increased risk of developing m-MCA was associated with leukoaraiosis and an elevated level of microalbuminuria.

Influence of Temperature Chronobiology on Stroke Outcome

“…Interestingly, the peak of ischemic stroke risk was stablished between 6 and 12 h [ 22 ], in the time when the temperature is still low, but begins to rise [ 11 ]. On the other hand, higher body temperature has been widely associated with poor outcomes [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ], which was also observed in our results regardless of the stroke time. However, our data also showed that the percentage of poor outcomes at 3 months was significantly higher precisely in the group of patients admitted at night, which had exhibited the lowest temperature at admission.…”

“…Temperature has a significant impact on the clinical course of stroke patients. Thus, higher temperature leads to poor outcomes in stroke [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. In addition, the increase in body temperature could affect the efficacy of reperfusion in these patients [ 17 , 28 ].…”

“…Thus, alterations in the circadian rhythmicity of body temperature could have a clinical association with different kinds of diseases and their severity, including trauma, infection, cancer and inflammatory response [ 11 ]. In fact, an increase in body temperature has been significantly associated with severity, mortality and poor outcomes in stroke survivors [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”