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Early temperature and mortality in critically ill patients with acute neurological diseases: trauma and stroke differ from infection.

Saxena M, Young P, Pilcher D, Bailey M, Harrison D, Bellomo R, Finfer S, Beasley R, Hyam J, Menon D, Rowan K, Myburgh J - Intensive Care Med (2015)

Bottom Line: Retrospective cohort design from 2005 to 2013, including 934,159 admissions to 148 ICUs in Australia and New Zealand (ANZ) and 908,775 admissions to 236 ICUs in the UK.For patients with CNS infection, elevated peak temperature was not associated with an increased risk of death, relative to the risk at 37-37.4 °C (normothermia).For CNS infection, increased temperature is not associated with increased risk of death.

View Article: PubMed Central - PubMed

Affiliation: Critical Care and Trauma Division, George Institute for Global Health, Sydney, NSW, Australia, m.saxena@unsw.edu.au.

ABSTRACT

Background: Fever suppression may be beneficial for patients with traumatic brain injury (TBI) and stroke, but for patients with meningitis or encephalitis [central nervous system (CNS) infection], the febrile response may be advantageous.

Objective: To evaluate the relationship between peak temperature in the first 24 h of intensive care unit (ICU) admission and all-cause hospital mortality for acute neurological diseases.

Design, setting and participants: Retrospective cohort design from 2005 to 2013, including 934,159 admissions to 148 ICUs in Australia and New Zealand (ANZ) and 908,775 admissions to 236 ICUs in the UK.

Results: There were 53,942 (5.8 %) patients in ANZ and 56,696 (6.2 %) patients in the UK with a diagnosis of TBI, stroke or CNS infection. For both the ANZ (P = 0.02) and UK (P < 0.0001) cohorts there was a significant interaction between early peak temperature and CNS infection, indicating that the nature of the relationship between in-hospital mortality and peak temperature differed between TBI/stroke and CNS infection. For patients with CNS infection, elevated peak temperature was not associated with an increased risk of death, relative to the risk at 37-37.4 °C (normothermia). For patients with stroke and TBI, peak temperature below 37 °C and above 39 °C was associated with an increased risk of death, compared to normothermia.

Conclusions: The relationship between peak temperature in the first 24 h after ICU admission and in-hospital mortality differs for TBI/stroke compared to CNS infection. For CNS infection, increased temperature is not associated with increased risk of death.

No MeSH data available.


Related in: MedlinePlus

ANZ and UK data showing adjusted odds ratios for in-hospital mortality versus peak temperature in the first 24 h after ICU admission: traumatic brain injury, acute ischaemic stroke and subarachnoid haemorrhage/intracerebral haemorrhage
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Fig2: ANZ and UK data showing adjusted odds ratios for in-hospital mortality versus peak temperature in the first 24 h after ICU admission: traumatic brain injury, acute ischaemic stroke and subarachnoid haemorrhage/intracerebral haemorrhage

Mentions: Associations between peak temperature recorded in the first 24 h of ICU admission and hospital mortality, relative to the risk at a normal temperature between 37 and 37.4 °C, are shown in Tables 2 and 3 and Figs. 1 and 2. The pattern of risk of death was similar for TBI, ischaemic stroke and haemorrhagic stroke. For both the ANZ (P = 0.02) and UK (P < 0.0001) cohorts there was a significant interaction between early peak temperature and CNS infection, indicating that the nature of the relationship between in-hospital mortality and peak temperature differed between TBI/stroke and CNS infection.Table 2


Early temperature and mortality in critically ill patients with acute neurological diseases: trauma and stroke differ from infection.

Saxena M, Young P, Pilcher D, Bailey M, Harrison D, Bellomo R, Finfer S, Beasley R, Hyam J, Menon D, Rowan K, Myburgh J - Intensive Care Med (2015)

ANZ and UK data showing adjusted odds ratios for in-hospital mortality versus peak temperature in the first 24 h after ICU admission: traumatic brain injury, acute ischaemic stroke and subarachnoid haemorrhage/intracerebral haemorrhage
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4414938&req=5

Fig2: ANZ and UK data showing adjusted odds ratios for in-hospital mortality versus peak temperature in the first 24 h after ICU admission: traumatic brain injury, acute ischaemic stroke and subarachnoid haemorrhage/intracerebral haemorrhage
Mentions: Associations between peak temperature recorded in the first 24 h of ICU admission and hospital mortality, relative to the risk at a normal temperature between 37 and 37.4 °C, are shown in Tables 2 and 3 and Figs. 1 and 2. The pattern of risk of death was similar for TBI, ischaemic stroke and haemorrhagic stroke. For both the ANZ (P = 0.02) and UK (P < 0.0001) cohorts there was a significant interaction between early peak temperature and CNS infection, indicating that the nature of the relationship between in-hospital mortality and peak temperature differed between TBI/stroke and CNS infection.Table 2

Bottom Line: Retrospective cohort design from 2005 to 2013, including 934,159 admissions to 148 ICUs in Australia and New Zealand (ANZ) and 908,775 admissions to 236 ICUs in the UK.For patients with CNS infection, elevated peak temperature was not associated with an increased risk of death, relative to the risk at 37-37.4 °C (normothermia).For CNS infection, increased temperature is not associated with increased risk of death.

View Article: PubMed Central - PubMed

Affiliation: Critical Care and Trauma Division, George Institute for Global Health, Sydney, NSW, Australia, m.saxena@unsw.edu.au.

ABSTRACT

Background: Fever suppression may be beneficial for patients with traumatic brain injury (TBI) and stroke, but for patients with meningitis or encephalitis [central nervous system (CNS) infection], the febrile response may be advantageous.

Objective: To evaluate the relationship between peak temperature in the first 24 h of intensive care unit (ICU) admission and all-cause hospital mortality for acute neurological diseases.

Design, setting and participants: Retrospective cohort design from 2005 to 2013, including 934,159 admissions to 148 ICUs in Australia and New Zealand (ANZ) and 908,775 admissions to 236 ICUs in the UK.

Results: There were 53,942 (5.8 %) patients in ANZ and 56,696 (6.2 %) patients in the UK with a diagnosis of TBI, stroke or CNS infection. For both the ANZ (P = 0.02) and UK (P < 0.0001) cohorts there was a significant interaction between early peak temperature and CNS infection, indicating that the nature of the relationship between in-hospital mortality and peak temperature differed between TBI/stroke and CNS infection. For patients with CNS infection, elevated peak temperature was not associated with an increased risk of death, relative to the risk at 37-37.4 °C (normothermia). For patients with stroke and TBI, peak temperature below 37 °C and above 39 °C was associated with an increased risk of death, compared to normothermia.

Conclusions: The relationship between peak temperature in the first 24 h after ICU admission and in-hospital mortality differs for TBI/stroke compared to CNS infection. For CNS infection, increased temperature is not associated with increased risk of death.

No MeSH data available.


Related in: MedlinePlus