Refining the Association of Fever with Functional Outcome in Aneurysmal Subarachnoid Hemorrhage

Christopher L. Kramer, Marianna Pegoli, Jayawant Mandrekar, Giuseppe Lanzino, Alejandro Rabinstein

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: We analyzed the impact of cause, severity, and duration of fever on functional outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: Fever characteristics were analyzed in 584 consecutive patients with aSAH. Fever was defined as core body temperature ≥38.3 °C on ≥2 consecutive days. Subfebrile measurements were those between 37 and 38.2 °C. Febrile and subfebrile loads were the number of hours with fever or subfebrile measurements, respectively. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. Results: Febrile measurements were observed in 281/584 (48.1 %) patients, recurring over a mean duration of 2.1 ± 3.0 days. Early fever within 24 and 72 h was encountered in 69 (11.9 %) and 110 (18.9 %) of patients, respectively. An infectious source was discovered in 126 (44.8 %) febrile patients. On univariate analysis, days of fever, febrile load, and fever onset within 24 and 72 h were associated with poor outcome (all p < 0.001); but subfebrile load was not (p = 0.56). On multivariate model constructed with all variables associated with outcome on univariate analyses, days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95 % CI 1.06–1.22; p = 0.0006) displacing all other fever measures from the final model. Conclusions: Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, subfebrile load does not influence clinical outcome. These data suggest prolonged fever should be avoided, but subfebrile temperatures may not justify intervention.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalNeurocritical Care
DOIs
StateAccepted/In press - Jul 14 2016

Fingerprint

Subarachnoid Hemorrhage
Fever
Logistic Models
Body Temperature

Keywords

  • All infections
  • Aneurysm
  • Central fever
  • Fever
  • Prognosis
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Refining the Association of Fever with Functional Outcome in Aneurysmal Subarachnoid Hemorrhage. / Kramer, Christopher L.; Pegoli, Marianna; Mandrekar, Jayawant; Lanzino, Giuseppe; Rabinstein, Alejandro.

In: Neurocritical Care, 14.07.2016, p. 1-7.

Research output: Contribution to journalArticle

@article{83d3c29778174fa98afd54ec6767eaf9,
title = "Refining the Association of Fever with Functional Outcome in Aneurysmal Subarachnoid Hemorrhage",
abstract = "Introduction: We analyzed the impact of cause, severity, and duration of fever on functional outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: Fever characteristics were analyzed in 584 consecutive patients with aSAH. Fever was defined as core body temperature ≥38.3 °C on ≥2 consecutive days. Subfebrile measurements were those between 37 and 38.2 °C. Febrile and subfebrile loads were the number of hours with fever or subfebrile measurements, respectively. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. Results: Febrile measurements were observed in 281/584 (48.1 {\%}) patients, recurring over a mean duration of 2.1 ± 3.0 days. Early fever within 24 and 72 h was encountered in 69 (11.9 {\%}) and 110 (18.9 {\%}) of patients, respectively. An infectious source was discovered in 126 (44.8 {\%}) febrile patients. On univariate analysis, days of fever, febrile load, and fever onset within 24 and 72 h were associated with poor outcome (all p < 0.001); but subfebrile load was not (p = 0.56). On multivariate model constructed with all variables associated with outcome on univariate analyses, days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95 {\%} CI 1.06–1.22; p = 0.0006) displacing all other fever measures from the final model. Conclusions: Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, subfebrile load does not influence clinical outcome. These data suggest prolonged fever should be avoided, but subfebrile temperatures may not justify intervention.",
keywords = "All infections, Aneurysm, Central fever, Fever, Prognosis, Subarachnoid hemorrhage",
author = "Kramer, {Christopher L.} and Marianna Pegoli and Jayawant Mandrekar and Giuseppe Lanzino and Alejandro Rabinstein",
year = "2016",
month = "7",
day = "14",
doi = "10.1007/s12028-016-0281-7",
language = "English (US)",
pages = "1--7",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",

}

TY - JOUR

T1 - Refining the Association of Fever with Functional Outcome in Aneurysmal Subarachnoid Hemorrhage

AU - Kramer, Christopher L.

AU - Pegoli, Marianna

AU - Mandrekar, Jayawant

AU - Lanzino, Giuseppe

AU - Rabinstein, Alejandro

PY - 2016/7/14

Y1 - 2016/7/14

N2 - Introduction: We analyzed the impact of cause, severity, and duration of fever on functional outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: Fever characteristics were analyzed in 584 consecutive patients with aSAH. Fever was defined as core body temperature ≥38.3 °C on ≥2 consecutive days. Subfebrile measurements were those between 37 and 38.2 °C. Febrile and subfebrile loads were the number of hours with fever or subfebrile measurements, respectively. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. Results: Febrile measurements were observed in 281/584 (48.1 %) patients, recurring over a mean duration of 2.1 ± 3.0 days. Early fever within 24 and 72 h was encountered in 69 (11.9 %) and 110 (18.9 %) of patients, respectively. An infectious source was discovered in 126 (44.8 %) febrile patients. On univariate analysis, days of fever, febrile load, and fever onset within 24 and 72 h were associated with poor outcome (all p < 0.001); but subfebrile load was not (p = 0.56). On multivariate model constructed with all variables associated with outcome on univariate analyses, days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95 % CI 1.06–1.22; p = 0.0006) displacing all other fever measures from the final model. Conclusions: Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, subfebrile load does not influence clinical outcome. These data suggest prolonged fever should be avoided, but subfebrile temperatures may not justify intervention.

AB - Introduction: We analyzed the impact of cause, severity, and duration of fever on functional outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: Fever characteristics were analyzed in 584 consecutive patients with aSAH. Fever was defined as core body temperature ≥38.3 °C on ≥2 consecutive days. Subfebrile measurements were those between 37 and 38.2 °C. Febrile and subfebrile loads were the number of hours with fever or subfebrile measurements, respectively. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. Results: Febrile measurements were observed in 281/584 (48.1 %) patients, recurring over a mean duration of 2.1 ± 3.0 days. Early fever within 24 and 72 h was encountered in 69 (11.9 %) and 110 (18.9 %) of patients, respectively. An infectious source was discovered in 126 (44.8 %) febrile patients. On univariate analysis, days of fever, febrile load, and fever onset within 24 and 72 h were associated with poor outcome (all p < 0.001); but subfebrile load was not (p = 0.56). On multivariate model constructed with all variables associated with outcome on univariate analyses, days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95 % CI 1.06–1.22; p = 0.0006) displacing all other fever measures from the final model. Conclusions: Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, subfebrile load does not influence clinical outcome. These data suggest prolonged fever should be avoided, but subfebrile temperatures may not justify intervention.

KW - All infections

KW - Aneurysm

KW - Central fever

KW - Fever

KW - Prognosis

KW - Subarachnoid hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=84978861786&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978861786&partnerID=8YFLogxK

U2 - 10.1007/s12028-016-0281-7

DO - 10.1007/s12028-016-0281-7

M3 - Article

SP - 1

EP - 7

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

ER -