Department of Clinical Medicine and Surgery, Melbourne University, University of Melbourne, Parkville, Victoria, Australia.
Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurosurgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
World Neurosurg. 2021 Jun;150:e474-e481. doi: 10.1016/j.wneu.2021.03.031. Epub 2021 Mar 13.
Fever in aneurysmal subarachnoid hemorrhage (aSAH) has been associated with delayed cerebral ischemia (DCI), but its relevance in risk stratification has not been explored. This study investigated whether early temperature elevation following aSAH predicts impending clinical deterioration caused by DCI.
Relevant cases were identified from a prospectively maintained database for consecutive patients with aSAH treated at our center between July 2015 and January 2020. Temperature readings obtained every 2 hours for individual patients from admission through day 14 were recorded and analyzed. Demographic, clinical, treatment, and angiographic data were extracted from the electronic medical record. The primary end point was the occurrence of DCI (clinical and radiographic vasospasm). Multivariate logistic regression analyses were performed to account for patient age, smoking status, and VASOGRADE classification.
The study included 175 patients (124 women) with aSAH. The median age at diagnosis was 55.4 years (range, 20.5-87.2 years). Clinical DCI occurred in 58 patients; 2 (1.1%) responded to hemodynamic augmentation, and 56 (32.0%) required intra-arterial therapy. Temperature graphs showed a marked divergence on day 4 between clinical DCI and non-DCI groups (1.12°C ± 0.15°C and 0.76°C ± 0.08°C, respectively, P = 0.007). Patients with temperature elevation ≥2.5°C on day 4 or 5 compared with their admission temperature were more likely to clinically deteriorate owing to DCI (odds ratio 4.55, 95% confidence interval 1.31-15.77, P = 0.017).
Temperature elevation of ≥2.5°C on day 4 or 5 compared with baseline suggests a greater risk of clinical deterioration owing to DCI.
动脉瘤性蛛网膜下腔出血（aSAH）后的发热与迟发性脑缺血（DCI）有关，但尚未探讨其在风险分层中的相关性。本研究旨在探讨 aSAH 后早期体温升高是否预测即将发生由 DCI 引起的临床恶化。
从 2015 年 7 月至 2020 年 1 月期间在本中心治疗的连续 aSAH 患者的前瞻性维护数据库中确定了相关病例。记录并分析每位患者从入院到第 14 天每 2 小时获得的体温读数。从电子病历中提取人口统计学、临床、治疗和血管造影数据。主要终点是 DCI（临床和影像学血管痉挛）的发生。进行多变量逻辑回归分析以解释患者年龄、吸烟状况和 VASOGRADE 分类。
研究纳入了 175 名（124 名女性）aSAH 患者。诊断时的中位年龄为 55.4 岁（范围 20.5-87.2 岁）。58 例患者发生临床 DCI；2 例（1.1%）对血流动力学增强有反应，56 例（32.0%）需要动脉内治疗。在第 4 天，临床 DCI 组和非 DCI 组的体温曲线明显分离（分别为 1.12°C ± 0.15°C 和 0.76°C ± 0.08°C，P=0.007）。与入院时相比，第 4 天或第 5 天体温升高≥2.5°C 的患者更有可能因 DCI 而临床恶化（优势比 4.55，95%置信区间 1.31-15.77，P=0.017）。
与基线相比，第 4 天或第 5 天体温升高≥2.5°C 提示因 DCI 导致临床恶化的风险更高。
