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Refining the Association of Fever with Functional Outcome in Aneurysmal Subarachnoid Hemorrhage

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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.

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Author notes

  1. Marianna Pegoli

    Present address: U.O.C Anestesia e Rianimazione IRCCS Istituto delle scienze neurologhiche - Ausl di Bologna, Bologna, Italy

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Christopher L. Kramer, Marianna Pegoli & Alejandro A. Rabinstein

  2. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Jay Mandrekar

  3. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Giuseppe Lanzino

Authors
  1. Christopher L. Kramer
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  2. Marianna Pegoli
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  3. Jay Mandrekar
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  4. Giuseppe Lanzino
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  5. Alejandro A. Rabinstein
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Corresponding author

Correspondence to Christopher L. Kramer.

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Conflict of Interest

Drs. Kramer, Rabinstein, Pegoli, and Mandrekar report no disclosures. Dr. Lanzino reports a consultant relationship with eV3/Covidien and Codman.

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Kramer, C.L., Pegoli, M., Mandrekar, J. et al. Refining the Association of Fever with Functional Outcome in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 26, 41–47 (2017). https://doi.org/10.1007/s12028-016-0281-7

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  • DOI: https://doi.org/10.1007/s12028-016-0281-7

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