Impact of Fever on Outcome in Patients With Stroke and Neurologic Injury

Greer, David M.; Funk, Susan Ens; Reaven, Nancy L.; Ouzounelli, Myrsini; Uman, Gwen

doi:10.1161/strokeaha.108.521583

Cited by 378 publications

(246 citation statements)

References 23 publications

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“…Moreover, a correlation has been found between increases in temperature and higher values of intracranial pressure in patients after SAH and head trauma [13]. A collective meta-analysis involving 14,431 patients with brain injuries has revealed that fever correlates with poorer prognosis and higher mortality [34].…”

Section: Consequences Of Central Fevermentioning

confidence: 99%

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

Zawadzka¹,

Szmuda²,

Mazurkiewicz-Bełdzińska³

2017

Anaesthesiol Intensive Ther

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Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment. The aim of this review is to present the current treatment options for the management of central fever and to analyze recent recommendations for the treatment of hyperthermia, including the use of hypothermia. The recommendations of American and European associations are inconsistent, mainly due to the lack of randomized clinical trials confirming the effectiveness of such treatment. The diagnosis of central fever is still made by the exclusion of other causes. The authors of the review intended to present the characteristic features of central fever, differentiating this state from infectious fever and also analyze the presence of central fever in particular neurological diseases. It seems particularly important to establish diagnostic criteria for central fever or to find diagnostic markers. It is also necessary to conduct further randomized clinical trials evaluating the indications for treatment of hyperthermia.

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Section: Consequences Of Central Fevermentioning

confidence: 99%

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

Zawadzka¹,

Szmuda²,

Mazurkiewicz-Bełdzińska³

2017

Anaesthesiol Intensive Ther

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“…of brain injury, 9,25 early recognition of this condition and modulation of the physiopathological mechanisms leading to dysthermia may be part of strategies aimed at limiting systemic complications, primary and secondary neuronal injury, and improving long-term outcomes. 16 Although much is known about the effects of dysthermia on neurological outcomes after brain injury, only limited data based on neurological diagnosis are available for addressing the epidemiology and risk factors of this phenomenon.…”

mentioning

confidence: 99%

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

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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 ...

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“…Previous studies have shown that body temperature elevation is associated with the clinical severity and prognosis of stroke (12)(13)(14). Elevated body temperature is also a risk factor for the hemorrhagic transformation of acute ischemic stroke when recombinant tissue-type plasminogen activator treatment is not applied to patients (15).…”

Section: A B Cmentioning

confidence: 99%

Reduction of the systemic inflammatory induced by acute cerebral infarction through ultra-early thrombolytic therapy

Ruowei

Yang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Acute ischemic stroke induces systemic inflammation, exhibited as changes in body temperature, white blood cell counts and C-reactive protein (CRP) levels. The aim of the present study was to observe the effects of intravenous thrombolytic therapy on inflammatory indices in order to investigate the hypothesis that post-stroke systemic inflammatory response occurs in response to the necrosis of brain tissues. In this study, 62 patients with acute cerebral infarction and indications for intravenous thrombolysis were divided into three groups on the basis of their treatment and response: Successful thrombolysis (n=36), failed thrombolysis (n=12) and control (n=14) groups. The body temperature, white blood cell counts and highsensitivity (hs)-CRP levels were recorded pre-treatment and on post-stroke days 1, 3, 5 and 7. Spearman's correlation analysis showed that the pre-treatment National Institutes of Health Stroke Scale (NIHSS) score positively correlated with body temperature, white blood cell count and hs-CRP levels. On day 3 of effective intravenous thrombolysis, the body temperature and white blood cell were decreased and on days 3 and 5, the serum levels of hs-CRP were reduced compared with those in the failed thrombolysis and control groups. The results indicate that the systemic inflammatory response following acute cerebral infarction was mainly caused by ischemic injury of local brain tissue; the more serious the stroke, the stronger the inflammatory response. Ultra-early thrombolytic therapy may inhibit the necrosis of brain tissue and thereby reduce the inflammatory response.

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Impact of Fever on Outcome in Patients With Stroke and Neurologic Injury

Cited by 378 publications

References 23 publications

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

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

Reduction of the systemic inflammatory induced by acute cerebral infarction through ultra-early thrombolytic therapy

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