Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Resuscitation. 2013 Dec;84(12):1734-40. doi: 10.1016/j.resuscitation.2013.07.023. Epub 2013 Aug 2.
Post-cardiac arrest fever has been associated with adverse outcome before implementation of therapeutic hypothermia (TH), however the prognostic implications of post-hypothermia fever (PHF) in the era of modern post-resuscitation care including TH has not been thoroughly investigated. The aim of the study was to assess the prognostic implication of PHF in a large consecutive cohort of comatose survivors after out-of-hospital cardiac arrest (OHCA) treated with TH.
In the period 2004-2010, a total of 270 patients resuscitated after OHCA and surviving a 24-h protocol of TH with a target temperature of 32-34°C were included. The population was stratified in two groups by median peak temperature (≥38.5°C) within 36h after rewarming: PHF and no-PHF. Primary endpoint was 30-days mortality and secondary endpoint was neurological outcome assessed by Cerebral Performance Category (CPC) at hospital discharge.
PHF (≥38.5°C) was associated with a 36% 30-days mortality rate compared to 22% in patients without PHF, plog-rank=0.02, corresponding to an adjusted hazard rate (HR) of 1.8 (95% CI: 1.1-2.7), p=0.02). The maximum temperature (HR=2.0 per °C above 36.5°C (95% CI: 1.4-3.0), p=0.0005) and the duration of PHF (HR=1.6 per 8h (95% CI: 1.3-2.0), p<0.0001) were also independent predictors of 30-days mortality in multivariable models. Good neurological outcome (CPC1-2) versus unfavourable outcome (CPC3-5) at hospital discharge was found in 61% vs. 39% in the PHF group compared to 75% vs. 25% in the No PHF group, p=0.02.
Post-hypothermia fever ≥38.5°C is associated with increased 30-days mortality, even after controlling for potential confounding factors. Avoidance of PHF as a therapeutic target should be evaluated in prospective randomized trials.
心脏停搏后发热与接受治疗性低温（TH）前的不良预后相关，然而，在包括 TH 在内的现代复苏后治疗时代，低温后发热（PHF）的预后意义尚未得到充分研究。本研究的目的是评估在接受 TH 治疗的院外心脏骤停（OHCA）昏迷幸存者的大型连续队列中，PHF 的预后意义。
在 2004 年至 2010 年期间，共纳入 270 例 OHCA 后复苏并接受 24 小时 TH 方案（目标温度 32-34°C）的存活患者。根据复温后 36 小时内的中位数峰值温度（≥38.5°C）将人群分层为两组：PHF 和非 PHF。主要终点为 30 天死亡率，次要终点为出院时通过脑功能预后分类（CPC）评估的神经功能结局。
PHF（≥38.5°C）组的 30 天死亡率为 36%，而非 PHF 组为 22%，log-rank=0.02，校正后的危险比（HR）为 1.8（95%CI：1.1-2.7），p=0.02）。最高温度（HR=每升高 2°C 2.0（95%CI：1.4-3.0），p=0.0005）和 PHF 持续时间（HR=每 8 小时增加 1.6（95%CI：1.3-2.0），p<0.0001）也是多变量模型中 30 天死亡率的独立预测因素。出院时神经功能良好（CPC1-2）与不良结局（CPC3-5）的比例在 PHF 组分别为 61%和 39%，而非 PHF 组分别为 75%和 25%，p=0.02。
即使在控制了潜在混杂因素后，≥38.5°C 的低温后发热与 30 天死亡率增加相关。应在前瞻性随机试验中评估避免 PHF 作为治疗目标的效果。
