Subarachnoid Extension of Primary Intracerebral Hemorrhage is Associated with Fevers
Subarachnoid Extension of Primary Intracerebral Hemorrhage is Associated with Fevers
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DOI：
10.1007/s12028-013-9888-0
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发表时间：
2014-04-01
影响因子：
3.5
通讯作者：
Maas, Matthew B.
中科院分区：
文献类型：
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作者：
Guth, James C.;Nemeth, Alexander J.;Maas, Matthew B.
原发性脑出血（ICH）中出血扩展到蛛网膜下腔与不良结局相关，尽管这种相关性的机制尚不确定。本研究的目的是确认发热和脑出血后不良预后之间的关系，并确定蛛网膜下腔出血扩展（SAHE）是否与发热有关。SAHE由设盲的专家评审员通过成像确定。每小时记录患者体温，我们将发热定义为前14天内记录的任何体温> 38 A ℃。开发了回归模型来测试发烧是否与不良结局相关，以及SAHE的发生是否是发烧的预测因素。在研究的235名患者中，39.7%患有SAHE，58%患有发烧。校正ICH评分后，发热与3个月时改良兰金评分较高相关（比值比，OR 1.8 [1.04-3.12]，p = 0.04）。调整ICH评分后，SAHE是发热的预测因子（OR 1.82 [95%置信区间1.02-3.24]，p = 0.04），调整其他混杂因素（如单变量分析中确定的肺炎）后，SAHE仍具有显著性。我们的数据证实了发热对ICH患者预后的有害影响，并表明SAHE是ICH后发热的独立预测因子。SAHE可能引起与蛛网膜下腔出血后观察到的类似的体温调节功能障碍，在SAHE和不良功能结局之间形成机制性通路。
Extension of hemorrhage into the subarachnoid space in primary intracerebral hemorrhage (ICH) has recently been associated with poor outcomes, although the mechanisms underlying that association are uncertain. The objectives of this study are to confirm the association between fever and poor outcomes after ICH, and to determine whether subarachnoid hemorrhage extension (SAHE) is associated with fevers.Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. SAHE was identified on imaging by blinded expert reviewers. Patient temperature was recorded hourly, and we defined febrile as any recorded temperature > 38 A degrees C within the first 14 days. Regression models were developed to test whether fever was associated with poor outcome and whether the occurrence of SAHE was a predictor of fever.Of the 235 patients studied, 39.7 % had SAHE and 58 % had fever. Fever was associated with higher modified Rankin scores at 3 months (odds ratio, OR 1.8 [1.04-3.12], p = 0.04) after adjustment for ICH score. SAHE was a predictor of fevers (OR 1.82 [95 % confidence interval 1.02-3.24], p = 0.04) after adjustment for ICH score, and remained significant after adjustment for other confounders like pneumonia identified in the univariate analysis.Our data confirm the deleterious effect of fever on the outcome of patients with ICH and show that SAHE is an independent predictor of fever after ICH. SAHE may provoke dysfunctional thermoregulation similar to what is observed after aneurysmal subarachnoid hemorrhage, creating mechanistic pathway between SAHE and poor functional outcomes.