Effect of Hyperthermia on Prognosis After Acute Ischemic Stroke

Saini, Monica; Saqqur, Maher; Kamruzzaman, Anmmd; Lees, Kennedy R.; Shuaib, Ashfaq

doi:10.1161/strokeaha.109.556134

Cited by 108 publications

(101 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study confirms results from previous reports addressing the effect of dysthermia on clinical outcomes after brain injury. 9,25,31,32 Our results also suggest that the effect of fever on case fatality varies with the type of neurological injury. This may suggest disease-specific mechanisms in the onset of fever, which could contribute to worsening neurological outcomes depending on the type of brain injury.…”

Section: Discussionsupporting

confidence: 59%

See 1 more Smart Citation

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

View full text Add to dashboard Cite

Brain injuries from stroke and head trauma are leading causes of morbidity and death in the world. 3,27 In patients with these injuries, early fever 9 and hypothermia 13,29 (dysthermia) and the onset of systemic complications are associated with poor outcomes. Plausible theories of the underlying reasons for disturbance in thermoregulation after brain injury are based on observations in animal models. These findings suggest that potential causes of fever include damage to the hypothalamus, midbrain, or pons by enhanced sympathetic activity; acute or delayed ischemia; toxic blood metabolites; physical distortion; or inflammation.7,34 Accordingly, dysfunction of or damage to these thermoregulatory pathways is common in patients with brain injuries, putting them at increased risk for dysthermia. 7,30,34 Because dysthermia is known to be associated with poor outcomes in all forms Object. Fever and hypothermia (dysthermia) are associated with poor outcomes in patients with brain injuries. The authors sought to study the epidemiology of dysthermia on admission to the intensive care unit (ICU) and the effect on in-hospital case fatality in a mixed cohort of patients with brain injuries.Methods. The authors conducted a multicenter retrospective cohort study in 94 ICUs in the United States. Critically ill patients with neurological injuries, including acute ischemic stroke (AIS), aneurysmal subarachnoid hemorrhage (aSAH), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), who were older than 17 years and consecutively admitted to the ICU from 2003 to 2008 were selected for analysis.Results. In total, 13,587 patients were included in this study; AIS was diagnosed in 2973 patients (22%), ICH in 4192 (31%), aSAH in 2346 (17%), and TBI in 4076 (30%). On admission to the ICU, fever was more common among TBI and aSAH patients, and hypothermia was more common among ICH patients. In-hospital case fatality was more common among patients with hypothermia (OR 12.7,) than among those with fever (OR 1.9, 95% CI 1.7-2.1). Compared with patients with ICH (OR 2.0, 95% CI 1.8-2.3), TBI (OR 1.5, 95% CI 1.3-1.8), and aSAH (OR 1.4, 95% CI 1.2-1.7), patients with AIS who developed fever had the highest risk of death (OR 3.1, 95% CI 2.5-3.7). Although all hypothermic patients had an increased mortality rate, this increase was not significantly different across subgroups. In a multivariable analysis, when adjusted for all other confounders, exposure to fever (adjusted OR 1.3, 95% CI 1.1-1.5) or hypothermia (adjusted OR 7.8, 95% CI 3.9-15.4) on admission to the ICU was found to be significantly associated with in-hospital case fatality.Conclusions. Fever is frequently encountered in the acute phase of brain injury, and a small proportion of patients with brain injuries may also develop spontaneous hypothermia. The effect of fever on mortality rates differed by neurological diagnosis. Both early spontaneous fever and hypothermia conferred a higher risk of in-hospital death after brain injury. Abbreviations used in this paper: AIS ...

show abstract

Section: Discussionsupporting

confidence: 59%

“…9,25,31,32 We also identified spontaneous hypothermia among a small proportion of these patients. Both fever and hypothermia were independently associated with increased in-hospital case fatality even after adjustment for other confounders during admission and ICU stay.…”

Section: Discussionmentioning

confidence: 83%

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Rincón

Hunter²,

Schorr

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…Early temperature elevation in ischemic tissue may result from a different mechanism from that which elevates body temperature, as body temperature may not peak until several days after stroke 17 and temperature in DWI-normal brain was higher at the second scan. The mechanisms by which brain or body cooling lead to improved outcomes in animal models after stroke-or potentially in patients-are uncertain, and there may be other important intermediate biomarkers of treatment efficacy.…”

Section: Discussionmentioning

confidence: 99%

Do acute phase markers explain body temperature and brain temperature after ischemic stroke?

Whiteley¹,

Thomas²,

Lowe³

et al. 2012

Neurology

View full text Add to dashboard Cite

Objective: Both brain and body temperature rise after stroke but the cause of each is uncertain.We investigated the relationship between circulating markers of inflammation with brain and body temperature after stroke. Methods:We recruited patients with acute ischemic stroke and measured brain temperature at hospital admission and 5 days after stroke with multivoxel magnetic resonance spectroscopic imaging in normal brain and the acute ischemic lesion (defined by diffusion-weighted imaging [DWI]). We measured body temperature with digital aural thermometers 4-hourly and drew blood daily to measure interleukin-6, C-reactive protein, and fibrinogen, for 5 days after stroke. Results:In 44 stroke patients, the mean temperature in DWI-ischemic brain soon after admission was 38.4°C (95% confidence interval [CI] 38.2-38.6), in DWI-normal brain was 37.7°C (95% CI 37.6-37.7), and mean body temperature was 36.6°C (95% CI 36.3-37.0). Higher mean levels of interleukin-6, C-reactive protein, and fibrinogen were associated with higher temperature in DWInormal brain at admission and 5 days, and higher overall mean body temperature, but only with higher temperature in DWI-ischemic brain on admission.Conclusions: Systemic inflammation after stroke is associated with elevated temperature in normal brain and the body but not with later ischemic brain temperature. Elevated brain temperature is a potential mechanism for the poorer outcome observed in stroke patients with higher levels of circulating inflammatory markers. Neurology ® 2012;79:152-158 GLOSSARY CI ϭ confidence interval; DVT ϭ deep venous thrombosis; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; FOV ϭ field of view; 1 H MRSI ϭ proton magnetic resonance spectroscopy imaging; IL-6 ϭ interleukin-6; IQR ϭ interquartile range; MR ϭ magnetic resonance; MRS ϭ magnetic resonance spectroscopy; NIHSS ϭ NIH Stroke Scale; PRESS ϭ point resolved spectroscopy.After ischemic stroke, the temperature in areas of brain affected by ischemia is higher than in unaffected brain and the rest of the body.1 Investigators have proposed clinical trials of therapeutic hypothermia, in patients with ischemic stroke, 2 based on the observations that hypothermia more than halves the size of cerebral infarcts in animal models, 3 and in stroke patients higher body temperature is associated with poorer outcome. 4 The processes that determine brain temperature after human ischemic stroke are uncertain. Animal studies suggest that in health, brain temperature is a balance between heat-generating metabolic processes and cooling by cerebral blood flow, 5 though in disease other mechanisms may be important. We have shown previously that there may be dissociation between metabolic activity and heat generation in ischemic brain.

show abstract

“…Fever is shown to increase the metabolic demand and consequently the oxygen consumption which worse the condition in case of ICU patients (3). For example, in acute stroke, fever associated with high rate of morbidity and mortality which reached up to 20% (15,16). Therefore, by the administration of acetaminophen, the metabolic demand decreases and the condition become better.…”

Section: Discussionmentioning

confidence: 99%

Acetaminophen in critically ill patients with fever

Mahmood¹

2016

IOSRPHR

View full text Add to dashboard Cite

Abstract:-Background: Acetaminophen is one of the most treatments used to reduce the temperature in ICU patients. However, it is still unclear whether the use of acetaminophen improves patients' survival and hospital length of stay. This study aims to analyze the main literatures which studied the use of acetaminophen in ICU patients with fever due to infections or other non-infectious insults. Methods:Severaldatabases including Cochrane library database, Academic Search Complete, and PubMed were searched for studies on acetaminophen in ICU patients. The search was limited to randomized controlled trials, cohort studies, adult human critically ill patients, treatment with acetaminophen in one arm and no treatment (placebo) in the other arm. The outcomes assessed were the ICU and hospital length of stay, mortality rate, ICU-free days and changes in temperature. Results:Two randomized control trials and one cohort study covering 32,408 patients were included. There wereno differences in ICU and hospital length of stay between the group treated with acetaminophen and placebo. In addition, the mortality rate did not differ between the two groups in patients with fever due to infection; however, a difference was shown in patients with fever due to non-infectious insults. Finally, there was a significant reduction in temperature in acetaminophen group compared to placebo. Conclusion: The use of acetaminophen for fever in critically ill patients was not associated with better outcome in terms of ICU and hospital length of stay and mortality ratecompared to placebo especially when the fever is due to infections.

show abstract

Effect of Hyperthermia on Prognosis After Acute Ischemic Stroke

Cited by 108 publications

References 45 publications

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Do acute phase markers explain body temperature and brain temperature after ischemic stroke?

Acetaminophen in critically ill patients with fever

Contact Info

Product

Resources

About