Markedly Deranged Injury Site Metabolism and Impaired... : Critical Care Medicine (original) (raw)

Neurologic Critical Care

Markedly Deranged Injury Site Metabolism and Impaired Functional Recovery in Acute Spinal Cord Injury Patients With Fever

Gallagher, Mathew J. MB, ChB1; Zoumprouli, Argyro MD2; Phang, Isaac PhD, MRCS1; Schwab, Jan M. MD, PhD3,4,5; Kopp, Marcel A. MD3,6; Liebscher, Thomas MD4; Papadopoulos, Marios C. MD1; Saadoun, Samira PhD1

1Academic Neurosurgery Unit, Molecular and Clinical Sciences Institute, St. George’s, University of London, London, United Kingdom.

2Neurointensive Care Unit, Department of Anaesthesia and Intensive Care Medicine, St. George’s Hospital, London, United Kingdom.

3Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Charité—Universitätsmedizin Berlin, Berlin, Germany.

4Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany.

5Department of Neurology, Division of Spinal Cord Injury, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH.

6Berlin Institute of Health, QUEST – Center for Transforming Biomedical Research, Berlin, Germany.

London patients were monitored and followed up at St. George’s Hospital, London, United Kingdom. Analysis of Berlin patient data was done at Trauma Hospital, Berlin, Germany.

Drs. Papadopoulos and Saadoun are cosenior authors.

Supported, in part, by Wings for Life Spinal Cord Research Foundation (to Drs. Papadopoulos and Saadoun), Fletcher Fund (to Dr. Papadopoulos), Neurosciences Research Foundation (to Drs. Gallagher and Papadopoulos), and London Deanery (to Dr. Gallagher).

Drs. Gallagher’s and Papadopoulos’s institutions received funding from the Wings for Life spinal cord research foundation and the Neurosciences Research Foundation. Dr. Schwab is an OSU Discovery Theme Scholar and received support by the Era-Net-NEURON Program of the European Union (SILENCE Grant #01EW170A), NIDILRR (Grant #90SI5020), and the W.E. Hunt & C.M. Curtis Endowment. Dr. Kopp received funding from the Italian Ministry of Health (reviewer). Dr. Saadoun’s institution received funding from research grants. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Abstract

Objectives:

To characterize the effect of fever after acute, traumatic spinal cord injury on injury site metabolism and patient outcome.

Design:

Longitudinal cohort study. In 44 patients (London cohort), we determined the effect of fever on intrathecal injury site metabolism by analyzing 1,767 hours of intraspinal pressure and 759 hours of microdialysis data. We also determined the effect of fever burden, computed for the first 2 weeks in hospital, on neurologic outcome. A distinct cohort of 33 patients (Berlin cohort) was used to independently validate the effect of fever burden on outcome.

Setting:

ICUs in London and Berlin.

Patients:

Seventy-seven patients with acute, traumatic spinal cord injuries.

Interventions:

In the London patients, a pressure probe and a microdialysis catheter were placed intradurally on the surface of the injured cord for up to a week.

Measurements and Main Results:

Fever (> 37.5°C) occurs frequently (37% of the time) after spinal cord injury. High-grade fever (≥ 38°C) was associated with significantly more deranged metabolite levels than normothermia (36.5–37.5°C), that is, lower tissue glucose (median 2.0 vs 3.3 mM), higher lactate (7.8 vs 5.4 mM), higher glutamate (7.8 vs 6.4 µM), and higher lactate-to-pyruvate ratio (38.9 vs 29.3). High-grade fever was particularly detrimental on injury site metabolism when the peripheral leukocyte count was high. In the London and Berlin cohorts, high fever burden correlated with less neurologic improvement.

Conclusions:

Early after spinal cord injury, fever is associated with more deranged injury site metabolism than normothermia and worse prognosis.