Brain Injury as a Risk Factor for Fever Upon Admission to the Intensive Care Unit and Association With In-Hospital Case Fatality

Journal of Intensive Care Medicine - Tập 30 Số 2 - Trang 107-114 - 2015
Fred Rincón1, Utkal Patel1, Christa Schorr1, Elizabeth Lee1, Steven E. Ross2, R. Phillip Dellinger1, S.L. Zanotti-Cavazzoni1
1Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA
2Department of Surgery, Division of Trauma and Critical Care, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA

Tóm tắt

Purpose: To test the hypothesis that fever was more frequent in critically ill patients with brain injury when compared to nonneurological patients and to study its effect on in-hospital case fatality. Methods: Retrospective matched cohort study utilizing a single-center prospectively compiled registry. Critically ill neurological patients ≥18 years and consecutively admitted to the intensive care unit (ICU) with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI) were selected. Patients were matched by sex, age, and Acute Physiology and Chronic Health Evaluation II (APACHE-II) to a cohort of nonneurological patients. Fever was defined as any temperature ≥37.5°C within the first 24 hours upon admission to the ICU. The primary outcome measure was in-hospital case fatality. Results: Mean age among neurological patients was 65.6 ± 15 years, 46% were men, and median APACHE-II was 15 (interquartile range 11-20). There were 18% AIS, 27% ICH, and 6% TBI. More neurological patients experienced fever than nonneurological patients (59% vs 47%, P = .007). The mean hospital length of stay was higher for nonneurological patients (18 ± 20 vs 14 ± 15 days, P = .007), and more neurological patients were dead at hospital discharge (29% vs 20%, P < .0001). After risk factor adjustment, diagnosis (neurological vs nonneurological), and the probability of being exposed to fever (propensity score), the following variables were associated with higher in-hospital case fatality: APACHE-II, neurological diagnosis, mean arterial pressure, cardiovascular and respiratory dysfunction in ICU, and fever (odds ratio 1.9, 95% confidence interval 1.04-3.6, P = .04). Conclusion: These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality.

Từ khóa


Tài liệu tham khảo

10.1161/CIR.0b013e31823ac046

Coronado VG, 2011, MMWR Surveill Summ, 60, 1

10.1097/CCM.0b013e3181aa5e8d

10.1097/CCM.0b013e3181962ad5

10.1212/WNL.48.3.768

10.1097/01.CCM.0000050323.84293.11

10.1161/STROKEAHA.108.521583

10.1161/01.STR.31.2.410

10.1136/jnnp.71.4.448

10.1007/s00134-002-1513-1

10.1161/01.STR.31.2.404

10.1161/STROKEAHA.109.556134

10.1007/s12028-012-9779-9

10.1212/01.wnl.0000258543.45879.f5

10.1212/WNL.56.10.1299

10.1097/01.CCM.0000129484.61912.84

10.1016/j.jcrc.2011.02.009

10.1007/s12028-010-9347-0

10.1089/neu.2010.1384

10.1212/WNL.54.2.354

10.1097/CCM.0b013e318169eda9

10.1093/epirev/mxg002

10.1080/00273171.2011.568786

10.1016/S0140-6736(07)61602-X

10.1161/01.STR.0000125858.71051.ca

10.1097/01.CCM.0000266585.74905.5A

10.1016/S0306-9877(98)90022-6

10.1016/S0025-6196(11)64885-4

10.1016/j.jns.2007.04.030

10.1161/01.STR.26.11.2040

10.1161/01.STR.29.12.2455

10.1001/archinte.161.16.2007

10.1212/01.WNL.0000133204.81153.AC

10.1016/S0140-6736(96)90008-2

Dietrich WD, 1992, J Neurotrauma, 9, S475

10.1097/00006123-200010000-00011

10.3389/fneur.2010.00146

10.1080/02656730500159079

10.1161/01.STR.30.4.905

Guidelines for the management of severe traumatic brain injury, 2007, J Neurotrauma, 24, S1, 10.1089/neu.2006.0209

10.1161/CIRCULATIONAHA.107.181486

10.1161/STROKEAHA.108.191395

Thông tin
Thông tin xuất bản

Journal of Intensive Care Medicine

Tập 30 Số 2

107-114

Thông tin tác giả