Christopher L Kramer1, Marianna Pegoli2,3, Jay Mandrekar4, Giuseppe Lanzino5, Alejandro A Rabinstein2. 1. Department of Neurology, Mayo Clinic, Rochester, MN, USA. ckramer82@gmail.com. 2. Department of Neurology, Mayo Clinic, Rochester, MN, USA. 3. U.O.C Anestesia e Rianimazione IRCCS Istituto delle scienze neurologhiche - Ausl di Bologna, Bologna, Italy. 4. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 5. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
Abstract
INTRODUCTION: We analyzed the impact of cause, severity, and duration of fever on functional outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Fever characteristics were analyzed in 584 consecutive patients with aSAH. Fever was defined as core body temperature ≥38.3 °C on ≥2 consecutive days. Subfebrile measurements were those between 37 and 38.2 °C. Febrile and subfebrile loads were the number of hours with fever or subfebrile measurements, respectively. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. RESULTS: Febrile measurements were observed in 281/584 (48.1 %) patients, recurring over a mean duration of 2.1 ± 3.0 days. Early fever within 24 and 72 h was encountered in 69 (11.9 %) and 110 (18.9 %) of patients, respectively. An infectious source was discovered in 126 (44.8 %) febrile patients. On univariate analysis, days of fever, febrile load, and fever onset within 24 and 72 h were associated with poor outcome (all p < 0.001); but subfebrile load was not (p = 0.56). On multivariate model constructed with all variables associated with outcome on univariate analyses, days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95 % CI 1.06-1.22; p = 0.0006) displacing all other fever measures from the final model. CONCLUSIONS: Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, subfebrile load does not influence clinical outcome. These data suggest prolonged fever should be avoided, but subfebrile temperatures may not justify intervention.
INTRODUCTION: We analyzed the impact of cause, severity, and duration of fever on functional outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS:Fever characteristics were analyzed in 584 consecutive patients with aSAH. Fever was defined as core body temperature ≥38.3 °C on ≥2 consecutive days. Subfebrile measurements were those between 37 and 38.2 °C. Febrile and subfebrile loads were the number of hours with fever or subfebrile measurements, respectively. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. RESULTS: Febrile measurements were observed in 281/584 (48.1 %) patients, recurring over a mean duration of 2.1 ± 3.0 days. Early fever within 24 and 72 h was encountered in 69 (11.9 %) and 110 (18.9 %) of patients, respectively. An infectious source was discovered in 126 (44.8 %) febrile patients. On univariate analysis, days of fever, febrile load, and fever onset within 24 and 72 h were associated with poor outcome (all p < 0.001); but subfebrile load was not (p = 0.56). On multivariate model constructed with all variables associated with outcome on univariate analyses, days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95 % CI 1.06-1.22; p = 0.0006) displacing all other fever measures from the final model. CONCLUSIONS: Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, subfebrile load does not influence clinical outcome. These data suggest prolonged fever should be avoided, but subfebrile temperatures may not justify intervention.
Entities:
Keywords:
All infections; Aneurysm; Central fever; Fever; Prognosis; Subarachnoid hemorrhage
Authors: J Oliveira-Filho; M A Ezzeddine; A Z Segal; F S Buonanno; Y Chang; C S Ogilvy; G Rordorf; L H Schwamm; W J Koroshetz; C T McDonald Journal: Neurology Date: 2001-05-22 Impact factor: 9.910
Authors: Elias A Giraldo; Jay N Mandrekar; Mark N Rubin; Stefan A Dupont; Yi Zhang; Giuseppe Lanzino; Eelco F M Wijdicks; Alejandro A Rabinstein Journal: J Neurosurg Date: 2012-04-27 Impact factor: 5.115
Authors: Mellanie V Springer; J Michael Schmidt; Katja E Wartenberg; Jennifer A Frontera; Neeraj Badjatia; Stephan A Mayer Journal: Neurosurgery Date: 2009-12 Impact factor: 4.654
Authors: Michael M Todd; Bradley J Hindman; William R Clarke; James C Torner; Julie B Weeks; Emine O Bayman; Qian Shi; Christina M Spofford Journal: Neurosurgery Date: 2009-05 Impact factor: 4.654
Authors: Andrew M Naidech; Bernard R Bendok; Richard A Bernstein; Mark J Alberts; H Hunt Batjer; Charles M Watts; Thomas P Bleck Journal: Neurosurgery Date: 2008-08 Impact factor: 4.654
Authors: Katja E Wartenberg; J Michael Schmidt; Jan Claassen; Richard E Temes; Jennifer A Frontera; Noeleen Ostapkovich; Augusto Parra; E Sander Connolly; Stephan A Mayer Journal: Crit Care Med Date: 2006-03 Impact factor: 7.598
Authors: Sean N Neifert; Emily K Chapman; Michael L Martini; William H Shuman; Alexander J Schupper; Eric K Oermann; J Mocco; R Loch Macdonald Journal: Transl Stroke Res Date: 2020-10-19 Impact factor: 6.829