Department of Neurology, Division of Neurocritical Care, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Neurosurgery. 2010 Apr;66(4):696-700; discussion 700-1. doi: 10.1227/01.NEU.0000367618.42794.AA.
Fever during the first week after subarachnoid hemorrhage (SAH) is associated with poor outcome; however, eliminating fever has not been shown to improve outcome. We sought to explore the potential impact of induced normothermia using advanced fever control (AFC) methods on outcome after SAH.
We identified 40 consecutive febrile patients enrolled in the Columbia University SAH Outcomes Project between 2003 and 2005 who underwent AFC (37 degrees C) with a surface cooling device during the first 14 days after SAH and randomly matched by age, Hunt and Hess grade, and SAH sum score to 80 SAH patients who underwent conventional fever control between 1996 and 2004. Average daily fever burden was calculated as the time and extent (degrees C x hours) above 37 degrees C. Poor outcome was defined as death or moderate to severe disability (modified Rankin Scale score of 4 or higher). A multivariate analysis was performed to identify factors associated with poor outcome 12 months after SAH.
The fever burden was lower over 14 days in the AFC patients as compared with the patients receiving conventional fever control (P < .001). AFC patients had higher rates of hyperglycemia (P < .01) and arrhythmias (P = .02). Higher admission Hunt and Hess grade on admission and the development of pneumonia (P = .02) were associated with an increased risk for poor outcome at 12 months (P = .04), whereas AFC was associated with a reduced risk (P = .004) after adjusting for age, arrhythmia, and anemia.
Elimination of fever with AFC may be associated with improved outcome after SAH. A prospective randomized trial of AFC vs conventional fever control is warranted.
蛛网膜下腔出血（SAH）后第一周发热与不良预后相关；然而，消除发热并未显示能改善预后。我们试图探讨使用高级发热控制（AFC）方法诱导正常体温对 SAH 后结局的潜在影响。
我们在 2003 年至 2005 年间识别了 40 例连续发热的哥伦比亚大学 SAH 结局项目患者，他们在 SAH 后 14 天内接受了 AFC（37°C），使用表面冷却设备，并通过年龄、Hunt 和 Hess 分级以及 SAH 总分与 1996 年至 2004 年间接受常规发热控制的 80 例 SAH 患者随机匹配。平均每日发热负担计算为高于 37°C 的时间和程度（摄氏度 x 小时）。不良预后定义为死亡或中度至重度残疾（改良 Rankin 量表评分 4 或更高）。进行多变量分析以确定与 SAH 后 12 个月不良预后相关的因素。
与接受常规发热控制的患者相比，AFC 患者在 14 天内发热负担较低（P <.001）。AFC 患者更易出现高血糖（P <.01）和心律失常（P =.02）。较高的入院 Hunt 和 Hess 分级和肺炎的发生（P =.02）与 12 个月时不良预后的风险增加相关（P =.04），而 AFC 与风险降低相关（P =.004），调整了年龄、心律失常和贫血等因素。
AFC 消除发热可能与 SAH 后预后改善相关。需要进行 AFC 与常规发热控制的前瞻性随机试验。
