创伤后的早期发热：有关系吗？
Early fever after trauma: Does it matter?
作者信息
Hinson Holly E, Rowell Susan, Morris Cynthia, Lin Amber L, Schreiber Martin A
机构信息
From the Department of Neurology (H.E.H.), Department of Emergency Medicine (H.E.H., A.L.L.), Department Trauma, Critical Care & Acute Surgery (S.R., M.A.S.), Department of Medical Informatics and Clinical Epidemiology (C.M.), Oregon Health & Science University, Portland, Oregon.
出版信息
J Trauma Acute Care Surg. 2018 Jan;84(1):19-24. doi: 10.1097/TA.0000000000001627.
BACKGROUND
Fever is strongly associated with poor outcome after traumatic brain injury (TBI). We hypothesized that early fever is a direct result of brain injury and thus would be more common in TBI than in patients without brain injury and associated with inflammation.
METHODS
We prospectively enrolled patients with major trauma with and without TBI from a busy Level I trauma center intensive care unit (ICU). Patients were assigned to one of four groups based on their presenting Head Abbreviated Injury Severity Scale scores: multiple injuries: head Abbreviated Injury Scale (AIS) score greater than 2, one other region greater than 2; isolated head: head AIS score greater than 2, all other regions less than 3; isolated body: one region greater than 2, excluding head/face; minor injury: no region with AIS greater than 2. Early fever was defined as at least one recorded temperature greater than 38.3°C in the first 48 hours after admission. Outcome measures included neurologic deterioration, length of stay in the ICU, hospital mortality, discharge Glasgow Outcome Scale-Extended, and plasma levels of seven key cytokines at admission and 24 hours (exploratory).
RESULTS
Two hundred sixty-eight patients were enrolled, including subjects with multiple injuries (n = 59), isolated head (n = 97), isolated body (n = 100), and minor trauma (n = 12). The incidence of fever was similar in all groups irrespective of injury (11-24%). In all groups, there was a significant association between the presence of early fever and death in the hospital (6-18% vs. 0-3%), as well as longer median ICU stays (3-7 days vs. 2-3 days). Fever was significantly associated with elevated IL-6 at admission (50.7 pg/dL vs. 16.9 pg/dL, p = 0.0067) and at 24 hours (83.1 pg/dL vs. 17.1 pg/dL, p = 0.0025) in the isolated head injury group.
CONCLUSION
Contrary to our hypothesis, early fever was not more common in patients with brain injury, though fever was associated with longer ICU stays and death in all groups. Additionally, fever was associated with elevated IL-6 levels in isolated head injury.
LEVEL OF EVIDENCE
Prognostic and Epidemiological study, level III.
背景
发热与创伤性脑损伤（TBI）后的不良预后密切相关。我们推测早期发热是脑损伤的直接结果，因此在TBI患者中比在无脑损伤患者中更常见，且与炎症相关。
方法
我们前瞻性地纳入了来自一家繁忙的一级创伤中心重症监护病房（ICU）的有和没有TBI的重大创伤患者。根据患者入院时的头部简明损伤严重程度量表评分，将患者分为四组：多发伤：头部简明损伤量表（AIS）评分大于2，其他一个部位大于2；单纯头部伤：头部AIS评分大于2，所有其他部位小于3；单纯身体伤：一个部位大于2，不包括头/面部；轻伤：无AIS大于2的部位。早期发热定义为入院后48小时内至少有一次记录体温大于38.3°C。结局指标包括神经功能恶化、ICU住院时间、医院死亡率、出院时格拉斯哥预后量表扩展版评分，以及入院时和24小时时（探索性）七种关键细胞因子的血浆水平。
结果
共纳入268例患者，包括多发伤患者（n = 59）、单纯头部伤患者（n = 97）、单纯身体伤患者（n = 100）和轻伤患者（n = 12）。无论损伤情况如何，所有组的发热发生率相似（11%-24%）。在所有组中，早期发热的存在与医院死亡之间存在显著关联（6%-18%对0%-3%），以及ICU中位住院时间更长（3-7天对2-3天）。在单纯头部损伤组中，发热与入院时（50.7 pg/dL对16.9 pg/dL，p = 0.0067）和24小时时（83.1 pg/dL对17.1 pg/dL，p = 0.0025）IL-6升高显著相关。
结论
与我们的假设相反，早期发热在脑损伤患者中并不更常见，尽管发热与所有组的ICU住院时间延长和死亡相关。此外，发热与单纯头部损伤中IL-6水平升高相关。
证据级别
预后和流行病学研究，三级。
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