Lai Pui Man Rosalind, See Alfred Pokmeng, Silva Michael A, Gormley William B, Frerichs Kai U, Aziz-Sultan M Ali, Du Rose
Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2019 Feb;122:e1014-e1019. doi: 10.1016/j.wneu.2018.10.203. Epub 2018 Nov 7.
The purpose of this study was to evaluate the association between noninfectious fever onset and radiographic vasospasm, delayed ischemic neurologic deficit (DIND), delayed cerebral infarction (DCI), and clinical outcome in patients with aneurysmal subarachnoid hemorrhage.
We evaluated 44 patients for the association between noninfectious fever (greater than 101.5°F) and the development of radiographic vasospasm by digital subtraction angiography (DSA) and transcranial Doppler (TCD), DIND, DCI, and modified Rankin scale outcome score at 6 months to 2 years. Multivariate logistic regression analyses were performed to account for patient age, sex, admission Hunt and Hess grade, and Fisher grade. TCD was additionally used for temporal analysis.
Noninfectious fever was significantly associated with radiographic vasospasm using both DSA (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.5; P = 0.02) and TCD (OR, 2.4; 95% CI, 1.2-5.6; P = 0.02), but it was not associated with DIND, DCI, or outcome. The maximum cross correlation between TCD velocity and temperature occurred for temperatures taken 1 day prior to TCD velocity measurement. A quadratic mixed-effects model demonstrated that TCD velocity was significantly associated with temperature from 1 day prior to TCD velocity measurement (β = 13.5; 95% CI, 0.83-8.79, P = 0.01), posthemorrhage day (β = 20.1; 95% CI, 2.14-7.52; P < 0.001), and (posthemorrhage day) (β = -0.72; 95% CI, -0.26 to -0.11; P < 0.001).
Noninfectious fever was associated with the development of radiographic vasospasm but not with DIND, DCI, or clinical outcome. Furthermore, there is a temporal association between the onset of noninfectious fever and radiographic vasospasm by 1 day. Fever independent of patient's infectious profile may be an early marker for the development of radiographic vasospasm.
本研究旨在评估非感染性发热的发作与动脉瘤性蛛网膜下腔出血患者的影像学血管痉挛、迟发性缺血性神经功能缺损（DIND）、迟发性脑梗死（DCI）及临床结局之间的关联。
我们评估了44例患者，以探讨非感染性发热（体温高于101.5°F）与通过数字减影血管造影（DSA）和经颅多普勒（TCD）检查发现的影像学血管痉挛、DIND、DCI以及6个月至2年时改良Rankin量表结局评分之间的关联。进行多因素逻辑回归分析，以考量患者年龄、性别、入院时Hunt和Hess分级以及Fisher分级。此外，TCD还用于时间分析。
使用DSA（比值比[OR]，2.2；95%置信区间[CI]，1.2 - 4.5；P = 0.02）和TCD（OR，2.4；95% CI，1.2 - 5.6；P = 0.02）均显示非感染性发热与影像学血管痉挛显著相关，但与DIND、DCI或结局无关。TCD速度与体温之间的最大交叉相关性出现在TCD速度测量前1天所测的体温中。二次混合效应模型表明，TCD速度与TCD速度测量前1天的体温（β = 13.5；95% CI，0.83 - 8.79，P = 0.01）、出血后天数（β = 20.1；95% CI，2.14 - 7.52；P < 0.001）以及（出血后天数）²（β = -0.72；95% CI，-0.26至-0.11；P < 0.001）显著相关。
非感染性发热与影像学血管痉挛的发生相关，但与DIND、DCI或临床结局无关。此外，非感染性发热发作与影像学血管痉挛之间存在1天的时间关联。与患者感染情况无关的发热可能是影像学血管痉挛发生的早期标志物。
