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

Rincón, Fred; Patel, Utkal; Schorr, Christa; Lee, Elizabeth; Ross, Steven E.; Dellinger, R. Phillip; Zanotti-Cavazzoni, S.L.

doi:10.1177/0885066613508266

Cited by 40 publications

(33 citation statements)

References 43 publications

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“…Our study confirms results from previous reports addressing the effect of dysthermia on clinical outcomes after brain injury. 9,25,31,32 Our results also suggest that the effect of fever on case fatality varies with the type of neurological injury. This may suggest disease-specific mechanisms in the onset of fever, which could contribute to worsening neurological outcomes depending on the type of brain injury.…”

Section: Discussionsupporting

confidence: 59%

“…9,25,31,32 We also identified spontaneous hypothermia among a small proportion of these patients. Both fever and hypothermia were independently associated with increased in-hospital case fatality even after adjustment for other confounders during admission and ICU stay.…”

Section: Discussionmentioning

confidence: 86%

“…However, it appears that the risk for poor outcome may be higher in critically ill, brain injury patients 25 when compared with patients with other injuries. 14 Rincon et al recently demonstrated that the risk of in-hospital death was higher in critically ill patients with neurological injuries who had fever than in critically ill patients with other injuries who had similar disease severities and who were also similar in terms of age, sex, acute physiological derangements, and comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…These cutoffs were defined a priori by consensus, and they conform to published results from clinical observations 14,22,25,31,33 and practice guidelines. 16 A preplanned secondary analysis was also performed, using a definition of fever as ≥ 38.3°C.…”

Section: Methodsmentioning

confidence: 99%

“…of brain injury, 9,25 early recognition of this condition and modulation of the physiopathological mechanisms leading to dysthermia may be part of strategies aimed at limiting systemic complications, primary and secondary neuronal injury, and improving long-term outcomes. 16 Although much is known about the effects of dysthermia on neurological outcomes after brain injury, only limited data based on neurological diagnosis are available for addressing the epidemiology and risk factors of this phenomenon.…”

mentioning

confidence: 99%

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

Rincón

Hunter²,

Schorr

et al. 2014

JNS

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Brain injuries from stroke and head trauma are leading causes of morbidity and death in the world. 3,27 In patients with these injuries, early fever 9 and hypothermia 13,29 (dysthermia) and the onset of systemic complications are associated with poor outcomes. Plausible theories of the underlying reasons for disturbance in thermoregulation after brain injury are based on observations in animal models. These findings suggest that potential causes of fever include damage to the hypothalamus, midbrain, or pons by enhanced sympathetic activity; acute or delayed ischemia; toxic blood metabolites; physical distortion; or inflammation.7,34 Accordingly, dysfunction of or damage to these thermoregulatory pathways is common in patients with brain injuries, putting them at increased risk for dysthermia. 7,30,34 Because dysthermia is known to be associated with poor outcomes in all forms 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,) 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 ...

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Rincón

Hunter²,

Schorr

et al. 2014

JNS

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Fever in Critical Neurologic Illness

Vespa

2014

JAMA

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The impact of fever as a testing indication on the detection rate of deep vein thrombosis in neurocritically ill patients

Henson,

Velasquez,

Martin

et al. 2023

Acute Medicine & Surgery

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AimDeep vein thrombosis (DVT) is considered a possible source of non‐infectious, non‐central fever in the intensive care unit (ICU). In the neurocritically ill, it is unknown whether lower extremity venous Doppler ultrasonography (LEVDUS) for DVT in the setting of fever leads to a higher detection rate than the baseline detection rate of DVT in this population. The aim of this study was to compare the DVT detection rate of LEVDUS performed for the indication of fever to LEVDUS performed for other indications in a neurosciences ICU.MethodsRequisition forms for all LEVDUS performed in a referral neurosciences ICU were reviewed and separated into those with “fever” as the stated reason for request and those with other stated reasons. The DVT detection rate was compared between these two categories of indications.ResultsFive hundred eleven LEVDUS were analyzed, of which 422 had been ordered for indications other than fever. Sixteen of these tests were positive, a detection rate of 3.8%. The remaining 89 LEVDUS had “fever” as the ordering indication. Six of these tests were positive for DVT, a detection rate of 6.7%. The likelihood of positivity of a test obtained as part of fever evaluation relative to one obtained for non‐fever indications was not significantly different (OR, 1.83; 95% CI, 0.570–5.11; P = 0.246).ConclusionLEVDUS triggered by fever detected DVT at a numerically, but not statistically significantly higher rate than did LEVDUS performed for other indications in a neurocritically ill population. More rigorous investigation of this question is needed.

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

Abstract: These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality.

Cited by 40 publications

References 43 publications

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

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

Fever in Critical Neurologic Illness

The impact of fever as a testing indication on the detection rate of deep vein thrombosis in neurocritically ill patients

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