Inflammation, edema and poor outcome are associated with hyperthermia in hypertensive intracerebral hemorrhages

Abstract

Background and purposeThe deleterious effect of hyperthermia on intracerebral hemorrhage (ICH) has been studied. However, the results are not conclusive and new studies are needed to elucidate clinical factors that influence the poor outcome. The aim of this study was to identify the clinical factors (including ICH etiology) that influence the poor outcome associated with hyperthermia and ICH. We also tried to identify potential mechanisms involved in hyperthermia during ICH.MethodsWe conducted a retrospective study enrolling patients with non‐traumatic ICH from a prospective registry. We used logistic regression models to analyze the influence of hyperthermia in relation to different inflammatory and endothelial dysfunction markers, hematoma growth and edema volume in hypertensive and non‐hypertensive patients with ICH.ResultsWe included 887 patients with ICH (433 hypertensive, 50 amyloid, 117 by anticoagulants and 287 with other causes). Patients with hypertensive ICH showed the highest body temperature (37.5 ± 0.8°C) as well as the maximum increase in temperature (0.9 ± 0.1°C) within the first 24 h. Patients with ICH of hypertensive etiologic origin, who presented hyperthermia, showed a 5.3‐fold higher risk of a poor outcome at 3 months. We found a positive relationship (r = 0.717, P < 0.0001) between edema volume and hyperthermia during the first 24 h but only in patients with ICH of hypertensive etiologic origin. This relationship seems to be mediated by inflammatory markers.ConclusionOur data suggest that hyperthermia, together with inflammation and edema, is associated with poor outcome only in ICH of hypertensive etiology.

Antihyperthermic treatment decreases perihematomal hypodensity

“…This is probably due to the multiple mechanisms that can condition the temperature increase in ICH, and the type of hemorrhage is undoubtedly one of these variables. 13 In our series, the therapeutic response was positive in only 31.1% of hypertensive ICH, in 42.9% of amyloid ICH, in 25.0% associated with antiplatelets/anticoagulants, and in 74.2% of indeterminate cases (p < 0.0001, data not shown in the Results). The overall benefit (determined as good outcome at 3 months) of patients who received antihyperthermic treatment was 31.8%.…”

“…[8][9][10] Hyperthermia has been associated with poor outcome in ICH 11 and with the increase of PHHD volume, 12 especially by hypertensive mechanisms. 13 Hypothermia has been proposed as a treatment for ICH that is associated with a decrease in PHHD. However, this kind of treatment is not recommended for patients with ICH due to the high morbidity and mortality, and more clinical trials are needed to verify its efficacy and safety.…”

Hypertension and its role in COVID-19-related cerebrovascular disease

“…Binding of SARS-CoV-2 to ACE2 receptors situated on lung and capillary epithelial cells triggers the formation of a cytokine storm characterized by an increased expression of inflammatory cytokines such as IL-1, IL-6, and TNF-α (16,23). Peripheral inflammation can lead to increased BBB permeability and the rupture of blood vessels causing brain edema and ICH (68). Cerebral SARS-CoV-2 infection activates CD4+ immune cells that in turn induce cytokine release from resident microglia and macrophages.…”

Inflammation, edema, hematoma and etiology – a rectangular relationship?

“…It was with great interest that we read the publication by Iglesias-Rey et al [1], who found an association of elevated body temperature with perihemorrhagic edema (PHE) evolution exclusively in hypertension-related intracerebral hemorrhage (ICH). In accordance with pathophysiologic findings, others found an independent association of PHE evolution with inflammatory parameters including fever in ICH without further etiological differentiation [2,3].…”