Fever burden and functional recovery after subarachnoid hemorrhage

Andrew M. Naidech, Bernard R. Bendok, Richard A. Bernstein, Mark J. Alberts, H. Hunt Batjer, Charles M. Watts, Thomas P. Bleck

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: Fever is associated with worse outcome after subarachnoid hemorrhage, but there are few prospective data to quantify this relationship. Methods: We prospectively enrolled consecutive aneurysmal or cryptogenic subarachnoid hemorrhage patients and recorded the highest core temperature each calendar day for Day 0 (the day of hemorrhage) through Day 13. Fever burden was defined as the daily highest core temperature minus 100.4°F, summed from admission through Day 13 (temperatures <100.4°F did not contribute to or subtract from fever burden). Outcomes were assessed at 14 days or at the time of hospital discharge with the National Institutes of Health Stroke Scale and modified Rankin Scale, and at 28 days and 3 months with the modified Rankin Scale. Improvement was analyzed with repeated measures analysis of variance. Results: We prospectively enrolled 94 patients. From 14 days to 28 days to 3 months, functional improvement was related to cumulative fever burden, admission neurological grade, aneurysm obliteration procedure, admission computed tomographic score, vasospasm, and external ventricular drainage. Good-grade patients had worse functional outcomes with increased fever burden, and poor-grade patients improved more over time when fever burden was higher (time by World Federation of Neurological Surgeons grade by fever burden interaction, P < 0.001). Patients with vasospasm (P = 0.04) and patients with higher computed tomographic scores (P = 0.002) had worse 14-day outcomes but improved more over time. Bacteremia and ventriculitis were uncommon (≤5%) and were not associated with higher fever burden. Conclusion: Cumulative fever burden was associated with worse outcomes in good-grade patients and potential late recovery in poor-grade patients. Effective fever control in febrile subarachnoid hemorrhage patients may improve functional outcomes and hasten recovery.

Original languageEnglish (US)
Pages (from-to)212-217
Number of pages6
JournalNeurosurgery
Volume63
Issue number2
DOIs
StatePublished - Aug 2008

Fingerprint

Subarachnoid Hemorrhage
Fever
Temperature
National Institutes of Health (U.S.)
Bacteremia
Aneurysm
Drainage
Analysis of Variance
Stroke
Hemorrhage

Keywords

  • Fever
  • Outcomes
  • Recovery
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Naidech, A. M., Bendok, B. R., Bernstein, R. A., Alberts, M. J., Batjer, H. H., Watts, C. M., & Bleck, T. P. (2008). Fever burden and functional recovery after subarachnoid hemorrhage. Neurosurgery, 63(2), 212-217. https://doi.org/10.1227/01.NEU.0000320453.61270.0F

Fever burden and functional recovery after subarachnoid hemorrhage. / Naidech, Andrew M.; Bendok, Bernard R.; Bernstein, Richard A.; Alberts, Mark J.; Batjer, H. Hunt; Watts, Charles M.; Bleck, Thomas P.

In: Neurosurgery, Vol. 63, No. 2, 08.2008, p. 212-217.

Research output: Contribution to journalArticle

Naidech, AM, Bendok, BR, Bernstein, RA, Alberts, MJ, Batjer, HH, Watts, CM & Bleck, TP 2008, 'Fever burden and functional recovery after subarachnoid hemorrhage', Neurosurgery, vol. 63, no. 2, pp. 212-217. https://doi.org/10.1227/01.NEU.0000320453.61270.0F
Naidech, Andrew M. ; Bendok, Bernard R. ; Bernstein, Richard A. ; Alberts, Mark J. ; Batjer, H. Hunt ; Watts, Charles M. ; Bleck, Thomas P. / Fever burden and functional recovery after subarachnoid hemorrhage. In: Neurosurgery. 2008 ; Vol. 63, No. 2. pp. 212-217.
@article{935bebaf3a0f408587b8bdbe6ab0112a,
title = "Fever burden and functional recovery after subarachnoid hemorrhage",
abstract = "Objective: Fever is associated with worse outcome after subarachnoid hemorrhage, but there are few prospective data to quantify this relationship. Methods: We prospectively enrolled consecutive aneurysmal or cryptogenic subarachnoid hemorrhage patients and recorded the highest core temperature each calendar day for Day 0 (the day of hemorrhage) through Day 13. Fever burden was defined as the daily highest core temperature minus 100.4°F, summed from admission through Day 13 (temperatures <100.4°F did not contribute to or subtract from fever burden). Outcomes were assessed at 14 days or at the time of hospital discharge with the National Institutes of Health Stroke Scale and modified Rankin Scale, and at 28 days and 3 months with the modified Rankin Scale. Improvement was analyzed with repeated measures analysis of variance. Results: We prospectively enrolled 94 patients. From 14 days to 28 days to 3 months, functional improvement was related to cumulative fever burden, admission neurological grade, aneurysm obliteration procedure, admission computed tomographic score, vasospasm, and external ventricular drainage. Good-grade patients had worse functional outcomes with increased fever burden, and poor-grade patients improved more over time when fever burden was higher (time by World Federation of Neurological Surgeons grade by fever burden interaction, P < 0.001). Patients with vasospasm (P = 0.04) and patients with higher computed tomographic scores (P = 0.002) had worse 14-day outcomes but improved more over time. Bacteremia and ventriculitis were uncommon (≤5{\%}) and were not associated with higher fever burden. Conclusion: Cumulative fever burden was associated with worse outcomes in good-grade patients and potential late recovery in poor-grade patients. Effective fever control in febrile subarachnoid hemorrhage patients may improve functional outcomes and hasten recovery.",
keywords = "Fever, Outcomes, Recovery, Subarachnoid hemorrhage, Vasospasm",
author = "Naidech, {Andrew M.} and Bendok, {Bernard R.} and Bernstein, {Richard A.} and Alberts, {Mark J.} and Batjer, {H. Hunt} and Watts, {Charles M.} and Bleck, {Thomas P.}",
year = "2008",
month = "8",
doi = "10.1227/01.NEU.0000320453.61270.0F",
language = "English (US)",
volume = "63",
pages = "212--217",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Fever burden and functional recovery after subarachnoid hemorrhage

AU - Naidech, Andrew M.

AU - Bendok, Bernard R.

AU - Bernstein, Richard A.

AU - Alberts, Mark J.

AU - Batjer, H. Hunt

AU - Watts, Charles M.

AU - Bleck, Thomas P.

PY - 2008/8

Y1 - 2008/8

N2 - Objective: Fever is associated with worse outcome after subarachnoid hemorrhage, but there are few prospective data to quantify this relationship. Methods: We prospectively enrolled consecutive aneurysmal or cryptogenic subarachnoid hemorrhage patients and recorded the highest core temperature each calendar day for Day 0 (the day of hemorrhage) through Day 13. Fever burden was defined as the daily highest core temperature minus 100.4°F, summed from admission through Day 13 (temperatures <100.4°F did not contribute to or subtract from fever burden). Outcomes were assessed at 14 days or at the time of hospital discharge with the National Institutes of Health Stroke Scale and modified Rankin Scale, and at 28 days and 3 months with the modified Rankin Scale. Improvement was analyzed with repeated measures analysis of variance. Results: We prospectively enrolled 94 patients. From 14 days to 28 days to 3 months, functional improvement was related to cumulative fever burden, admission neurological grade, aneurysm obliteration procedure, admission computed tomographic score, vasospasm, and external ventricular drainage. Good-grade patients had worse functional outcomes with increased fever burden, and poor-grade patients improved more over time when fever burden was higher (time by World Federation of Neurological Surgeons grade by fever burden interaction, P < 0.001). Patients with vasospasm (P = 0.04) and patients with higher computed tomographic scores (P = 0.002) had worse 14-day outcomes but improved more over time. Bacteremia and ventriculitis were uncommon (≤5%) and were not associated with higher fever burden. Conclusion: Cumulative fever burden was associated with worse outcomes in good-grade patients and potential late recovery in poor-grade patients. Effective fever control in febrile subarachnoid hemorrhage patients may improve functional outcomes and hasten recovery.

AB - Objective: Fever is associated with worse outcome after subarachnoid hemorrhage, but there are few prospective data to quantify this relationship. Methods: We prospectively enrolled consecutive aneurysmal or cryptogenic subarachnoid hemorrhage patients and recorded the highest core temperature each calendar day for Day 0 (the day of hemorrhage) through Day 13. Fever burden was defined as the daily highest core temperature minus 100.4°F, summed from admission through Day 13 (temperatures <100.4°F did not contribute to or subtract from fever burden). Outcomes were assessed at 14 days or at the time of hospital discharge with the National Institutes of Health Stroke Scale and modified Rankin Scale, and at 28 days and 3 months with the modified Rankin Scale. Improvement was analyzed with repeated measures analysis of variance. Results: We prospectively enrolled 94 patients. From 14 days to 28 days to 3 months, functional improvement was related to cumulative fever burden, admission neurological grade, aneurysm obliteration procedure, admission computed tomographic score, vasospasm, and external ventricular drainage. Good-grade patients had worse functional outcomes with increased fever burden, and poor-grade patients improved more over time when fever burden was higher (time by World Federation of Neurological Surgeons grade by fever burden interaction, P < 0.001). Patients with vasospasm (P = 0.04) and patients with higher computed tomographic scores (P = 0.002) had worse 14-day outcomes but improved more over time. Bacteremia and ventriculitis were uncommon (≤5%) and were not associated with higher fever burden. Conclusion: Cumulative fever burden was associated with worse outcomes in good-grade patients and potential late recovery in poor-grade patients. Effective fever control in febrile subarachnoid hemorrhage patients may improve functional outcomes and hasten recovery.

KW - Fever

KW - Outcomes

KW - Recovery

KW - Subarachnoid hemorrhage

KW - Vasospasm

UR - http://www.scopus.com/inward/record.url?scp=62649137550&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=62649137550&partnerID=8YFLogxK

U2 - 10.1227/01.NEU.0000320453.61270.0F

DO - 10.1227/01.NEU.0000320453.61270.0F

M3 - Article

C2 - 18797350

AN - SCOPUS:62649137550

VL - 63

SP - 212

EP - 217

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 2

ER -