急性脑出血早期发热的预后意义：INTERACT2研究

Prognostic significance of early pyrexia in acute intracerebral haemorrhage: The INTERACT2 study.

作者信息

Malavera Alejandra, You Shoujiang, Zheng Danni, Delcourt Candice, Anderson Craig S

机构信息

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, PR China.

出版信息

J Neurol Sci. 2021 Apr 15;423:117364. doi: 10.1016/j.jns.2021.117364. Epub 2021 Feb 26.

DOI:10.1016/j.jns.2021.117364

PMID:33647734

Abstract

INTRODUCTION

Uncertainty exists over the prognostic significance of pyrexia in acute intracerebral haemorrhage (ICH). We aimed to determine the association of elevated body temperature with clinical and imaging outcomes among participants of the main Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2).

METHODS

Post-hoc analyses of INTERACT2, an international open, blinded outcome assessed, randomised trial of 2839 patients with spontaneous ICH (<6 h of onset) and elevated systolic blood pressure (SBP, 150-220 mmHg) randomly assigned to intensive (SBP target <140 mmHg) or guideline-recommended (SBP target < 180 mmHg) BP management. Multivariable logistic regression was used to determine associations of elevated baseline body temperature (<37.5 vs. ≥37.5 °C) and 90-day clinical outcome defined on the modified Rankin scale (mRS). Analysis of covariance determined relations of body temperature and haematoma and perihaematomal oedema (PHE) volumes, at baseline and 24 h post-randomisation.

RESULTS

Of 2792 participants with data available at admission, 39 (1.4%) patients had elevated body temperature ≥ 37.5 °C. Elevated body temperature was significantly associated with 90-day mortality (adjusted odds ratio 2.44; 95% confidence interval 1.02-5.82; P = .044) but not with major disability alone (mRS scores 3-5) and combination death or major disability (mRS scores 3-6). Elevated body temperature was also associated with larger PHE volume at baseline (10.89 vs. 3.14 cm, P < .001;) and 24 h (12.43 vs 5.76 cm, P = .018) but not with haematoma volumes at these time points.

CONCLUSION

Early pyrexia in mild to moderate ICH is associated with greater mortality and larger PHE volume, suggesting an early inflammatory-mediated reaction.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov (NCT00716079).

摘要

引言

急性脑出血（ICH）发热的预后意义尚不确定。我们旨在确定急性脑出血强化降压试验（INTERACT2）主要参与者中体温升高与临床及影像学结局之间的关联。

方法

对INTERACT2进行事后分析，这是一项国际开放性、盲法评估结局的随机试验，纳入2839例自发性ICH（发病<6小时）且收缩压（SBP）升高（150 - 220 mmHg）的患者，随机分配至强化降压组（SBP目标<140 mmHg）或指南推荐降压组（SBP目标<180 mmHg）。采用多变量逻辑回归确定基线体温升高（<37.5℃与≥37.5℃）与改良Rankin量表（mRS）定义的90天临床结局之间的关联。协方差分析确定随机分组时及随机分组后24小时体温与血肿及血肿周围水肿（PHE）体积之间的关系。

结果

在2792例入院时有可用数据的参与者中，39例（1.4%）患者体温升高≥37.5℃。体温升高与90天死亡率显著相关（校正比值比2.44；95%置信区间1.02 - 5.82；P = 0.044），但与单独的严重残疾（mRS评分3 - 5）以及死亡或严重残疾合并情况（mRS评分3 - 6）无关。体温升高还与基线时更大的PHE体积相关（10.89 vs. 3.14 cm，P < 0.001）以及24小时时更大的PHE体积相关（12.43 vs 5.76 cm，P = 0.018），但与这些时间点的血肿体积无关。