Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest
Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest
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DOI：
10.1016/j.resuscitation.2013.07.023
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发表时间：
2013-12-01
期刊：
影响因子：
6.5
通讯作者：
Kjaergaard, Jesper
中科院分区：
文献类型：
--
作者：
Bro-Jeppesen, John;Hassager, Christian;Kjaergaard, Jesper
目的：在实施低温治疗（TH）之前，心脏骤停后发热与不良结局相关，然而，在包括 TH 在内的现代复苏后护理时代，低温后发热（PHF）的预后影响尚未得到彻底研究。本研究的目的是评估 PHF 对接受 TH 治疗的院外心脏骤停（OHCA）后昏迷幸存者的大型连续队列的预后影响。 2004 年至 2010 年，共有 270 名患者在 OHCA 后复苏，并在目标温度为 32-34 摄氏度的 24 小时 TH 方案中存活下来。根据复温后 36 小时内的中位峰值温度（≥ 38.5 摄氏度）将人群分为两组：PHF 和非 PHF。主要终点是 30 天死亡率，次要终点是出院时通过脑功能类别 (CPC) 评估的神经学结果。 结果：PHF（>38.5 摄氏度）与 36% 的 30 天死亡率相关，而无 PHF 的患者的 30 天死亡率为 22%，p（对数秩）= 0.02，对应于调整后的危险率 (HR) 1.8（95% CI： 1.1-2.7），p = 0.02）。在多变量模型中，最高温度（HR = 高于 36.5 摄氏度每摄氏度 2.0（95% CI：1.4-3.0），p = 0.0005）和 PHF 持续时间（HR = 1.6 每 8 小时（95% CI：1.3-2.0），p < 0.0001）也是多变量模型中 30 天死亡率的独立预测因子。出院时，PHF 组中良好的神经学结果 (CPC1-2) 与不良结果 (CPC3-5) 的比例分别为 61% 和 39%，而无 PHF 组的比例分别为 75% 和 25%，p = 0.02。结论：即使在控制了潜在的混杂因素后，低温后发热 >= 38.5 摄氏度与 30 天死亡率增加相关。应在前瞻性随机试验中评估避免 PHF 作为治疗目标的情况。 (C) 2013 Elsevier Ireland Ltd. 保留所有权利。
Objective: Post-cardiac arrest fever has been associated with adverse outcome before implementation of therapeutic hypothermia (TH), however the prognostic implications of post-hypothermia fever (PHF) in the era of modern post-resuscitation care including TH has not been thoroughly investigated.The aim of the study was to assess the prognostic implication of PHF in a large consecutive cohort of comatose survivors after out-of-hospital cardiac arrest (OHCA) treated with TH.Methods: In the period 2004-2010, a total of 270 patients resuscitated after OHCA and surviving a 24-h protocol of TH with a target temperature of 32-34 degrees C were included. The population was stratified in two groups by median peak temperature (>= 38.5 degrees C) within 36 h after rewarming: PHF and no-PHF. Primary endpoint was 30-days mortality and secondary endpoint was neurological outcome assessed by Cerebral Performance Category (CPC) at hospital discharge.Results: PHF (>38.5 degrees C)was associated with a 36% 30-days mortality rate compared to 22% in patients without PHF, p(log-rank) = 0.02, corresponding to an adjusted hazard rate (HR) of 1.8 (95% CI: 1.1-2.7), p = 0.02). The maximum temperature (HR = 2.0 per degrees C above 36.5 degrees C (95% CI: 1.4-3.0), p = 0.0005) and the duration of PHF (HR = 1.6 per 8 h (95% CI: 1.3-2.0), p < 0.0001) were also independent predictors of 30-days mortality in multivariable models. Good neurological outcome (CPC1-2) versus unfavourable outcome (CPC3-5) at hospital discharge was found in 61% vs. 39% in the PHF group compared to 75% vs. 25% in the No PHF group, p = 0.02.Conclusions: Post-hypothermia fever >= 38.5 degrees C is associated with increased 30-days mortality, even after controlling for potential confounding factors. Avoidance of PHF as a therapeutic target should be evaluated in prospective randomized trials. (C) 2013 Elsevier Ireland Ltd. All rights reserved.