Fred Rincon1, Utkal Patel2, Christa Schorr2, Elizabeth Lee2, Steven Ross3, R Phillip Dellinger2, Sergio Zanotti-Cavazzoni2. 1. Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA fred.rincon@jefferson.edu. 2. Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA. 3. Department of Surgery, Division of Trauma and Critical Care, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA.
Abstract
PURPOSE: To test the hypothesis that fever was more frequent in critically ill patients with brain injury when compared to nonneurological patients and to study its effect on in-hospital case fatality. METHODS: Retrospective matched cohort study utilizing a single-center prospectively compiled registry. Critically ill neurological patients ≥18 years and consecutively admitted to the intensive care unit (ICU) with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI) were selected. Patients were matched by sex, age, and Acute Physiology and Chronic Health Evaluation II (APACHE-II) to a cohort of nonneurological patients. Fever was defined as any temperature ≥37.5°C within the first 24 hours upon admission to the ICU. The primary outcome measure was in-hospital case fatality. RESULTS: Mean age among neurological patients was 65.6 ± 15 years, 46% were men, and median APACHE-II was 15 (interquartile range 11-20). There were 18% AIS, 27% ICH, and 6% TBI. More neurological patients experienced fever than nonneurological patients (59% vs 47%, P = .007). The mean hospital length of stay was higher for nonneurological patients (18 ± 20 vs 14 ± 15 days, P = .007), and more neurological patients were dead at hospital discharge (29% vs 20%, P < .0001). After risk factor adjustment, diagnosis (neurological vs nonneurological), and the probability of being exposed to fever (propensity score), the following variables were associated with higher in-hospital case fatality: APACHE-II, neurological diagnosis, mean arterial pressure, cardiovascular and respiratory dysfunction in ICU, and fever (odds ratio 1.9, 95% confidence interval 1.04-3.6, P = .04). CONCLUSION: These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality.
PURPOSE: To test the hypothesis that fever was more frequent in critically illpatients with brain injury when compared to nonneurological patients and to study its effect on in-hospital case fatality. METHODS: Retrospective matched cohort study utilizing a single-center prospectively compiled registry. Critically ill neurologicalpatients ≥18 years and consecutively admitted to the intensive care unit (ICU) with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI) were selected. Patients were matched by sex, age, and Acute Physiology and Chronic Health Evaluation II (APACHE-II) to a cohort of nonneurological patients. Fever was defined as any temperature ≥37.5°C within the first 24 hours upon admission to the ICU. The primary outcome measure was in-hospital case fatality. RESULTS: Mean age among neurological patients was 65.6 ± 15 years, 46% were men, and median APACHE-II was 15 (interquartile range 11-20). There were 18% AIS, 27% ICH, and 6% TBI. More neurological patients experienced fever than nonneurological patients (59% vs 47%, P = .007). The mean hospital length of stay was higher for nonneurological patients (18 ± 20 vs 14 ± 15 days, P = .007), and more neurological patients were dead at hospital discharge (29% vs 20%, P < .0001). After risk factor adjustment, diagnosis (neurological vs nonneurological), and the probability of being exposed to fever (propensity score), the following variables were associated with higher in-hospital case fatality: APACHE-II, neurological diagnosis, mean arterial pressure, cardiovascular and respiratory dysfunction in ICU, and fever (odds ratio 1.9, 95% confidence interval 1.04-3.6, P = .04). CONCLUSION: These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality.
Authors: Christopher L Kramer; Marianna Pegoli; Jay Mandrekar; Giuseppe Lanzino; Alejandro A Rabinstein Journal: Neurocrit Care Date: 2017-02 Impact factor: 3.210
Authors: Holly E Hinson; Susan Rowell; Cynthia Morris; Amber L Lin; Martin A Schreiber Journal: J Trauma Acute Care Surg Date: 2018-01 Impact factor: 3.313
Authors: Alois J Schiefecker; Mario Kofler; Max Gaasch; Ronny Beer; Iris Unterberger; Bettina Pfausler; Gregor Broessner; Peter Lackner; Paul Rhomberg; Elke Gizewski; Werner O Hackl; Miriam Mulino; Martin Ortler; Claudius Thome; Erich Schmutzhard; Raimund Helbok Journal: J Cereb Blood Flow Metab Date: 2017-04-24 Impact factor: 6.200