The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

Clinical article

Fred Rincon M.D., M.Sc., F.C.C.M. 1 , Krystal Hunter M.B.A. 2 , Christa Schorr R.N., M.S.N., F.C.C.M. 3 , R. Philip Dellinger M.D., M.C.C.M. 3 and Sergio Zanotti-Cavazzoni M.D., F.C.C.M. 3
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  • 1 Departments of Neurology and Neurosurgery, Division of Critical Care and Neurotrauma, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
  • 2 Departments of Biostatistics and
  • 3 Medicine, Division of Cardiovascular Diseases and Critical Care Medicine, Cooper University Hospital, Camden, New Jersey
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Object

Fever and hypothermia (dysthermia) are associated with poor outcomes in patients with brain injuries. The authors sought to study the epidemiology of dysthermia on admission to the intensive care unit (ICU) and the effect on in-hospital case fatality in a mixed cohort of patients with brain injuries.

Methods

The authors conducted a multicenter retrospective cohort study in 94 ICUs in the United States. Critically ill patients with neurological injuries, including acute ischemic stroke (AIS), aneurysmal subarachnoid hemorrhage (aSAH), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), who were older than 17 years and consecutively admitted to the ICU from 2003 to 2008 were selected for analysis.

Results

In total, 13,587 patients were included in this study; AIS was diagnosed in 2973 patients (22%), ICH in 4192 (31%), aSAH in 2346 (17%), and TBI in 4076 (30%). On admission to the ICU, fever was more common among TBI and aSAH patients, and hypothermia was more common among ICH patients. In-hospital case fatality was more common among patients with hypothermia (OR 12.7, 95% CI 8.4–19.4) than among those with fever (OR 1.9, 95% CI 1.7–2.1). Compared with patients with ICH (OR 2.0, 95% CI 1.8–2.3), TBI (OR 1.5, 95% CI 1.3–1.8), and aSAH (OR 1.4, 95% CI 1.2–1.7), patients with AIS who developed fever had the highest risk of death (OR 3.1, 95% CI 2.5–3.7). Although all hypothermic patients had an increased mortality rate, this increase was not significantly different across subgroups. In a multivariable analysis, when adjusted for all other confounders, exposure to fever (adjusted OR 1.3, 95% CI 1.1–1.5) or hypothermia (adjusted OR 7.8, 95% CI 3.9–15.4) on admission to the ICU was found to be significantly associated with in-hospital case fatality.

Conclusions

Fever is frequently encountered in the acute phase of brain injury, and a small proportion of patients with brain injuries may also develop spontaneous hypothermia. The effect of fever on mortality rates differed by neurological diagnosis. Both early spontaneous fever and hypothermia conferred a higher risk of in-hospital death after brain injury.

Abbreviations used in this paper:AIS = acute ischemic stroke; APACHE II = Acute Physiology And Chronic Health Evaluation II; aSAH = aneurysmal subarachnoid hemorrhage; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; ICU = intensive care unit; PI = Project IMPACT; TBI = traumatic brain injury.

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Contributor Notes

Address correspondence to: Fred Rincon, M.D., M.Sc., F.C.C.M., Department of Neurological Surgery, Thomas Jefferson University and Jefferson College of Medicine, Division of Critical Care and Neurotrauma, 909 Walnut St., 3rd Floor, Philadelphia, PA 19107. email: fred.rincon@jefferson.edu.

Please include this information when citing this paper: published online August 8, 2014; DOI: 10.3171/2014.7.JNS132470.

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