Effect of Hyperthermia on Prognosis After Acute Ischemic Stroke
Effect of Hyperthermia on Prognosis After Acute Ischemic Stroke
复制标题
DOI：
10.1161/strokeaha.109.556134
复制
发表时间：
2009-09-01
期刊：
影响因子：
8.3
通讯作者：
Shuaib, Ashfaq
中科院分区：
文献类型：
--
作者：
Saini, Monica;Saqqur, Maher;Shuaib, Ashfaq
背景和目的-实验研究表明，体温过高是缺血性卒中预后不良的决定因素。然而，评估温度对卒中后结局影响的临床研究受到样本量小的限制。我们试图评估温度和高温时机对缺血性中风后结局的影响。方法分析了虚拟国际中风试验档案（VISTA）数据集的5305名急性中风试验患者的数据。根据3个月时改良的兰金量表，评估基线、第8、24、48和72小时以及第7天的体温数据与结局（差vs好）的关系。体温过高定义为体温>37.2 ℃，预后不良定义为90天改良兰金量表>2分。报告了体温过高与结局相关的风险比及其95% CI。Logistic回归模型，在高温，适合一组预选协变量在不同的时间点，以确定预测/决定因素的hypertemia.Results-The患者的平均年龄为68.0 +/- 11.9岁，2380（44.9%）是女性，和42.3%（2233）接受溶栓使用重组组织型纤溶酶原激活剂。校正后，高热是不良预后的统计学显著预测因子。在不同时间点，与体温过高相关的不良结局的风险比（95% CI）为：基线1.2（1.0至1.4），第八小时1.7（1.2到2.2），24小时1.5（1.2到1.9），48小时2.0（1.5到2.6），72小时2.2（1.7到2.9），第七天2.7（2.0到3.8）。性别、卒中严重程度（国立卫生研究院卒中量表评分>16）、白色血细胞计数和抗生素使用与体温过高显著相关（P
Background and Purpose-Experimental studies have shown that hyperthermia is a determinant of poor outcome after ischemic stroke. Clinical studies evaluating the effect of temperature on poststroke outcome have, however, been limited by small sample sizes. We sought to evaluate the effect of temperature and timing of hyperthermia on outcome after ischemic stroke.Methods-Data of 5305 patients in acute stroke trials from the Virtual International Stroke Trials Archive (VISTA) data set were analyzed. Data for temperatures at baseline, eighth, 24th, 48th, and 72nd hours, and seventh day were assessed in relation to outcome (poor versus good) based on the modified Rankin Scale at 3 months. Hyperthermia was defined as temperature >37.2 degrees C and poor outcome as 90-day modified Rankin Scale >2. Hazard ratios with 95% CIs were reported for hyperthermia in relation to the outcome. Logistic regression models, in relation to hyperthermia, were fitted for a set of preselected covariates at different time points to identify predictors/determinants of hyperthermia.Results-The average age of patients was 68.0 +/- 11.9 years, 2380 (44.9%) were females, and 42.3% (2233) received thrombolysis using recombinant tissue plasminogen activator. After adjustment, hyperthermia was a statistically significant predictor of poor outcome. The hazard ratios (95% CI) for poor outcome in relation to hyperthermia at different time points were: baseline 1.2 (1.0 to 1.4), eighth hour 1.7 (1.2 to 2.2), 24th hour 1.5 (1.2 to 1.9), 48th hour 2.0 (1.5 to 2.6), 72nd hour 2.2 (1.7 to 2.9), and seventh day 2.7 (2.0 to 3.8). Gender, stroke severity (National Institutes of Health Stroke Scale score >16), white blood cell count, and antibiotic use were significantly associated with hyperthermia (P