Epidemiology and Outcomes of Fever Burden Among Patients With Acute Ischemic Stroke

Abstract

Background and Purpose— Although fever following ischemic stroke is common and has been associated with poor patient outcomes, little is known about which aspects of fever (eg, frequency, severity, or duration) are most associated with outcomes. Methods— We used data from a retrospective cohort of acute ischemic stroke patients who were admitted to 1 of 5 hospitals (1998–2003). A fever event was defined as a period with a temperature ≥100.0°F (37.8°C). Fever burden was defined as the maximum temperature (T max ) minus 100.0°F, multiplied by the number of days with a fever. Fever burden (in degree-days) was categorized as low (0.1–2.0), medium (2.1–4.0), or high (≥4.0). Logistic regression was used to evaluate the adjusted association of any fever episode and fever burden with the combined outcome of in-hospital mortality or discharge to hospice. Results— Among 1361 stroke patients, 483 patients (35.5%) had ≥1 fever event. Among febrile patients, the median T max was 100.9°F (range, 100.0–106.6°F), 87% had ≤2 events and median total fever days was 2. Patients with any fever event had higher combined outcome rates after adjusting for demographics, stroke severity, and clinical characteristics: adjusted odds ratio (aOR), 2.7 (95% CI, 1.6–4.4). Higher fever burden was also associated with the combined outcome: high burden aOR, 6.7 (95% CI, 3.6–12.7); medium burden aOR, 3.9 (95% CI, 1.9–8.2); and low burden aOR, 1.2 (95%CI, 0.6–2.3) versus no fever. Conclusions— This study confirms that poststroke fever occurs commonly and demonstrates that patients with high fever burden have a 6-fold increased odds of death or discharge to hospice.

Employment Status and Work-Related Difficulties among Family Members of Terminally Ill Patients Compared with the General Population

“…Fatigability was also a major reason for not working among cancer survivors in previous studies (Phipps et al, 2011;Flannelly et al, 2012). However, our findings were specific to caregivers of terminal cancer patients because we focused on comparing caregivers of terminal cancer patients with the general population.…”

“…ECOG PS was highly correlated with physical function (Smith et al, 2012) and is the main correlate of not working (Phipps et al, 2011;Gomes et al, 2012;Pantilat et al, 2012). Poor ECOG PS of a patient would become a greater stressor for the caregiver (Tordoff et al, 2012) and family caregivers of terminal cancer patients who had poor ECOG PS scores were likely to need more assistance with patients dependent on care for activities of daily living or IADL including help with transportation, shopping, homemaking, emotional support, nutritional care, nursing care, and personal care (Baker et al, 2011;Chochinov et al, 2011;Cohen et al, 2012;Fairfield et al, 2012;Gomes et al, 2012;Pantilat et al, 2012;Tordoff et al, 2012).…”

“…The final sample comprised 994 participants (response rate, 41%). The study population and data collection methods have been previously described elsewhere (Phipps et al, 2011).…”

“…If the choice items were not applicable, participants were asked to write in the reason for not working. The design of this study has been used previously (Phipps et al, 2011;Flannelly et al, 2012) …”

“…Employment status among family caregivers has especially important implications for society, the labor market, and family economics (Unroe et al, 2012). Although previous studies have focused on the return to work of cancer survivors Phipps et al, 2011;Flannelly et al, 2012;Unroe et al, 2012) and employment status among caregivers of cancer patients (Gomes et al, 2012;Pantilat et al, 2012), unfortunately, it is not fully understood how many family caregivers of terminal cancer patients maintain their employment status with caregiving. We aimed to evaluate employment status and work-related difficulties of family caregivers with terminal cancer patients, comparing with the general population.…”