Early fever after trauma: Does it matter?
Early fever after trauma: Does it matter?
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DOI：
10.1097/ta.0000000000001627
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发表时间：
2018-01-01
影响因子：
3.4
通讯作者：
Schreiber, Martin A.
中科院分区：
文献类型：
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作者：
Hinson, Holly E.;Rowell, Susan;Schreiber, Martin A.
发热与创伤性脑损伤（TBI）后的不良结局密切相关。我们假设，早期发热是脑损伤的直接结果，因此将是更常见的TBI比在没有脑损伤和相关inflammation.METHODS的患者，我们前瞻性地招募了重大创伤和无TBI的患者从一个忙碌I级创伤中心重症监护室（ICU）。根据患者目前的头部简明损伤严重程度量表评分，将患者分配到四组之一：多发性损伤：头部简明损伤量表（AIS）评分大于2，其他一个区域大于2;孤立性头部：头部AIS评分大于2，所有其他区域小于3;孤立性身体：一个区域大于2，不包括头部/面部;轻微损伤：没有AIS大于2的区域。早期发热定义为入院后前48小时内至少有一次记录的体温高于38.3摄氏度。结果指标包括神经功能恶化、ICU住院时间、住院死亡率、出院格拉斯哥结果量表-扩展、入院时和24小时内7种关键细胞因子的血浆水平结果共纳入268例患者，其中多发伤59例，孤立头97例，孤立体100例，轻度创伤12例。所有组的发热发生率相似，不考虑损伤（11-24%）。在所有组中，早期发热与住院死亡（6-18% vs. 0-3%）以及ICU中位住院时间（3-7天vs. 2-3天）之间存在显著相关性。入院时发热与IL-6升高显著相关（50.7 pg/dL vs. 16.9 pg/dL，p = 0.0067）和24小时时（83.1 pg/dL vs.17.1 pg/dL，p = 0.0025）结论与我们的假设相反，早期发热在脑损伤患者中并不常见，尽管在所有组中，发热与ICU停留时间和死亡时间相关。此外，发热与孤立性颅脑损伤患者IL-6水平升高相关。证据等级预后和流行病学研究，III级。
BACKGROUND Fever is strongly associated with poor outcome after traumatic brain injury (TBI). We hypothesized that early fever is a direct result of brain injury and thus would be more common in TBI than in patients without brain injury and associated with inflammation.METHODS We prospectively enrolled patients with major trauma with and without TBI from a busy Level I trauma center intensive care unit (ICU). Patients were assigned to one of four groups based on their presenting Head Abbreviated Injury Severity Scale scores: multiple injuries: head Abbreviated Injury Scale (AIS) score greater than 2, one other region greater than 2; isolated head: head AIS score greater than 2, all other regions less than 3; isolated body: one region greater than 2, excluding head/face; minor injury: no region with AIS greater than 2. Early fever was defined as at least one recorded temperature greater than 38.3 degrees C in the first 48 hours after admission. Outcome measures included neurologic deterioration, length of stay in the ICU, hospital mortality, discharge Glasgow Outcome Scale-Extended, and plasma levels of seven key cytokines at admission and 24 hours (exploratory).RESULTS Two hundred sixty-eight patients were enrolled, including subjects with multiple injuries (n = 59), isolated head (n = 97), isolated body (n = 100), and minor trauma (n = 12). The incidence of fever was similar in all groups irrespective of injury (11-24%). In all groups, there was a significant association between the presence of early fever and death in the hospital (6-18% vs. 0-3%), as well as longer median ICU stays (3-7 days vs. 2-3 days). Fever was significantly associated with elevated IL-6 at admission (50.7 pg/dL vs. 16.9 pg/dL, p = 0.0067) and at 24 hours (83.1 pg/dL vs. 17.1 pg/dL, p = 0.0025) in the isolated head injury group.CONCLUSION Contrary to our hypothesis, early fever was not more common in patients with brain injury, though fever was associated with longer ICU stays and death in all groups. Additionally, fever was associated with elevated IL-6 levels in isolated head injury.LEVEL OF EVIDENCE Prognostic and Epidemiological study, level III.