Central fever in patients with spontaneous intracerebral hemorrhage: predicting factors and impact on outcome

Abstract

BackgroundCentral fever (CF) is defined as elevated temperature with no identifiable cause. We aimed to identify risk factors for developing CF among patients with spontaneous intracerebral hemorrhage (ICH) and to evaluate the impact of CF on outcome.MethodsPatients included in our prospective stroke registry between 1/1/09 and 1/10/10 were studied. We identified patients with CF as those with a temperature ≥38.3°C without evidence for infection or drug fever. Patients with CF were compared to those without fever and those with infectious fever. Demographics, risk factors and imaging data as well as outcome parameters were reviewed.ResultsWe identified 95 patients with spontaneous ICH (median age 76, median admission NIHSS 9). CF was identified in 30 patients (32%), infectious etiology was found in 9 patients (9%) and the remaining patients did not develop fever. Baseline variables were similar between the groups except for intra-ventricular extension of the ICH (IVH) and larger ICH volumes that were more common in the CF group (OR = 4.667, 95% CI 1.658-13.135 and OR = 1.013/ml, 95% CI 1.004-1.021). Outcome analysis showed higher mortality rates (80% vs. 36%, p < 0.001) and lower rates of favorable functional outcome defined as a modified Rankin score ≤ 2 at 90 days (0% vs. 53%, p < 0.001) in the CF group.ConclusionsThe risk of CF is increased in patients with larger ICH and in those with IVH. CF negatively impacts outcome in patients with ICH.

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

“…Additionally, the quicker the onset of fever, the higher its value was. The above results are consistent with the earlier findings demonstrating that earlier-onset fever is most commonly of central origin and reaches high values (40-42 o C) [5].…”

“…The author defined this condition as a rapid increase in core body temperature at a low temperature of the integuments, occurring as a result of brain surgery [5]. However, the term of central hyperthermia remains controversial, especially that there are no diagnostic methods enabling the diagnosis at an early stage of the disease.…”

“…According to a prospective study by Honig et al [5] involving 95 patients with spontaneous intracerebral haemorrhage, central fever developed in 32% whereas infectious fever occurred in 9%. Analysis of the results revealed higher mortality and worse functional scores in the CF group assessed after 90 days using the modified Rankin scale.…”

“…When the system of thermoregulation is compromised at each level, thermoregulatory disorders develop [5]. Hyperthermia associated with impaired central mechanisms of thermoregulation is colloquially called "brain fever".…”

Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome

“…Fever has been reported in 30-40% of all ICH cases [50,51], which may be secondary to an infection or neurogenic. Infection-related fever is the most prevalent, and it could be due to a concurrent or hospital-acquired infection [51].…”