Body Temperature and Fibrinogen Are Related to Early Neurological Deterioration in Acute Ischemic Stroke (original) (raw)
Related papers
Elevated body temperature in ischemic stroke associated with neurological improvement
Acta Neurologica Scandinavica, 2017
Some studies suggest that high body temperature within the first few hours of ischemic stroke onset is associated with improved outcome. We hypothesized an association between high body temperature on admission and detectable improvement within 6-9 hours of stroke onset. Materials and Methods: Consecutive ischemic stroke patients with NIHSS scores obtained within 3 hours and in the interval 6-9 hours after stroke onset were included. Body temperature was measured on admission. Results: A total of 315 patients with ischemic stroke were included. Median NIHSS score on admission was 6. Linear regression showed that NIHSS score 6-9 hours after stroke onset was inversely associated with body temperature on admission after adjusting for confounders including NIHSS score <3 hours after stroke onset (P<.001). The same result was found in patients with proximal middle cerebral occlusion on admission. Conclusions: We found an inverse association between admission body temperature and neurological improvement within few hours after admission. This finding may be limited to patients with documented proximal middle cerebral artery occlusion on admission and suggests a beneficial effect of higher body temperature on clot lysis within the first three hours.
Vascular Health and Risk Management, 2012
Background: Hypothermia is considered neuroprotective and a potential treatment in cerebral ischemia. Some studies suggest that hyperthermia may promote clot lysis. We hypothesized that low body temperature would prolong time to spontaneous clot lysis resulting in an association between low body temperature and severe neurological deficits in the early phase of ischemic stroke. Methods: In this prospective study, patients (n = 516) exhibiting ischemic stroke with symptom onset within 6 hours were included. Body temperature and National Institute of Health Stroke Scale (NIHSS) score were registered on admission. Because low body temperature on admission may be secondary to immobilization due to large stroke, separate analyses were performed on patients with cerebral hemorrhage admitted within 6 hours (n = 85). Results: Linear regression showed that low body temperature on admission was independently associated with a high NIHSS score within 6 hours of stroke onset in patients with ischemic stroke (P , 0.001). The association persisted when NIHSS was measured at 24 hours after admission. No such associations were found in patients with cerebral hemorrhage admitted within 6 hours of stroke onset. Conclusion: Our study suggests that low body temperature within 6 hours of symptom onset is associated with severe ischemic stroke. This is in support of our hypothesis, although other contributing mechanisms cannot be excluded.
Body Temperature in Acute Stroke
Stroke, 2002
with interest the article by Di Napoli et al, 1 who reported the first-ever ischemic stroke to further analyze the relationship between C-reactive protein (CRP) values measured immediately and at different times after stroke, and the 1-year outcome. The important message of this article is that the relationship between CRP and prognosis after cerebral ischemia could be of greater utility for risk stratification and may predict future cardiovascular events or death. Ischemic cerebrovascular disease accounts for a substantial proportion of all strokes. Although the proximate cause of most brain infarcts is thrombus formation, atherosclerosis is the chief underlying cause. 2 CRP, one of the acute-phase reactants, is an indicator of underlying systemic inflammation and a novel plasma marker of atherothrombotic disease. 3 Furthermore, elevated plasma levels of CRP are not disease specific but are sensitive markers produced in response to tissue injury, infectious agents, immunologic stimuli, and inflammation. 4,5 Plasma CRP levels are known to be higher in smokers, obese individuals, individuals with abnormal fibrinolytic activity (plasmin-antiplasmin complex), and individuals with subclinical atherosclerosis. We believed that the use of plasma CRP levels may aid in identifying a potentially large number of men and women who are at risk for cerebrovascular events, as described by Rost et al. 5 Our clinical prospective data 6 from a large community-based cohort of men and women of stroke and transient ischemic attack demonstrate a strong association between CRP and fibrinogen in both sexes. In our cases, 25.3% of patients have normal levels of CRP after stroke, and our data indicate that 21.6% of patients with ischemic stroke who have CRP levels Ն1.5 mg/dL have died, as Di Napoli et al described. We have also detected that some of the ischemic stroke patients have history of the trauma. 6 As a result, the detection of especially CRP and fibrinogen is very important in patients with ischemic stroke and transient ischemic attack in determination of possible risk factors, subsequent vascular events or death, and severe neurological deficit and disability, and stratify poststroke patients into relatively high-risk groups.
The Time Course and Determinants of Temperature within the First 48 h after Ischaemic Stroke
Cerebrovascular Diseases, 2007
Background and Purpose: Previous research has attempted to analyze the relationship between post-stroke hyperthermia and prognosis. These analyses have been hindered by a lack of information about the time course and determinants of temperature change after stroke. Methods: Serial temperatures were measured until 48 h after ischaemic stroke in a prospectively recruited cohort. Potential determinants of temperature, including stroke severity [measured using the National Institutes of Health Stroke Scale (NIHSS)], infection and paracetamol use were recorded. Mixed-effects models were used to model serial temperature measurements over time, adjusted for significant determinants. Results: In 155 patients the mean temperature rose from 36.5°C at the time of stroke to 36.7°C approximately 36 h later. The factors with significant multivariable associations with serial temperatures were: first- and second-order time components, infection, paracetamol administration and the interaction betwe...
Journal of Integrative Neuroscience
Introduction: The aim of this study was to investigate for possible associations between an early increase in body temperature within 24 hours of endovascular therapy (EVT) for large vessel occlusion stroke and the presence of symptomatic intracranial hemorrhage (sICH) and other clinical outcomes. Methods: This was a retrospective study of consecutive patients with large vessel occlusion stroke who were treated with EVT from August 2018 to June 2021. Patients were divided into two groups based on the presence of fever, as defined by a Peak Body Temperature (PBT) of ≥37.3°C. The presence of sICH and other clinical outcomes were compared between the two groups. Results: The median NIHSS admission score (IQR) was 16.0 (12.0, 21.0), with higher NIHSS scores in the PBT ≥37.3°C group than in the PBT <37.3°C group (18 vs 14, respectively; p = 0.002). There were no differences in clinical outcomes at 3 months between patients with PBT <37.3°C and patients with PBT between 37.3°C and 38°C. However, patients with PBT ≥38°C had an increased risk of sICH (adjusted odds ratio (OR) = 8.8, 95% confidence interval (95% CI): 1.7-46.0; p = 0.01), increased inpatient death or hospice discharge (OR = 10.5, 95% CI: 2.0-53.9; p = 0.005), poorer clinical outcome (OR = 25.6, 95% CI: 5.2-126.8; p < 0.001), and increased 3-month mortality (OR = 6.6, 95% CI: 1.8-24.6; p = 0.01). Conclusions: Elevated PBT (≥38°C) within 24 hours of EVT was significantly associated with an increased incidence of symptomatic intracranial hemorrhage, discharge to hospice or inpatient death, poorer clinical outcome and 3-month mortality, and with less functional independence. Further large-scale, prospective and multicenter trials are needed to confirm these findings.
Body temperature and mortality in acute cerebral infarction
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
In animal models, a rise in body temperature after cerebral ischemia consistently produces more extensive brain damage. In humans, however the relationship between body temperature and stroke outcome has been far less extensively investigated, providing conflicting results. The objective of the present study is to determine whether body temperature recorded during the first 72 hours after admission is an independent predictor of mortality in acute cerebral infarction. The medical records of patients admitted within 48 hours of onset of symptoms to Prasat Neurological Institute between 1 January 2002 and 31 December 2003, with a diagnosis of cerebral infarction, confirmed by CT or MRI of the brain were retrospectively studied. The relationship between the highest temperature recorded during the first 72 hours after admission and mortality during hospital stay was evaluated. Multiple logistic regression analysis included relevant confounders and potential predictors such as gender, ag...
Early neurological worsening in acute ischaemic stroke patients
Acta Neurologica Scandinavica, 2015
Objectives-Neurological worsening in acute ischaemic stroke patients is common with significant morbidity and mortality. Aims-To determine the factors associated with early neurological worsening within the first 9 h after onset of acute ischaemic stroke. Materials & methods-The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity. Early neurological worsening was defined as NIHSS score increase ≥4 NIHSS points within 9 h of symptom onset compared to NIHSS score within 3 h of symptom onset. Patients with early neurological worsening were compared to patients with unchanged or improved NIHSS scores. Results-Of the 2484 patients admitted with ischaemic stroke, 552 patients had NIHSS score within 3 h of symptom onset, and 44 (8.0%) experienced early neurological worsening. The median NIHSS on admission was 8.4 in both groups. Early neurological worsening was associated with low body temperature on admission (P = 0.01), proximal compared to distal MCA occlusion (P = 0.007) and with ipsilateral internal carotid artery stenosis >50% or occlusion (P = 0.04). Early neurological worsening was associated with higher NIHSS day 7 (P < 0.001) and higher mortality within 7 days of stroke onset (P = 0.005). Conclusions-Early neurological worsening has serious consequences for the short-term outcome for patients with acute ischaemic stroke and is associated with low body temperature on admission, and with extracranially and intracranially large-vessel stenosis or occlusion.