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Table 2 Previous studies of body temperature and outcome after stoke – key results

From: Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome

First author and year

Key findings

Azzimondi 1995[2]

High fever (≥37.9°C) <7 d is independent risk factor for poor prognosis. Fever occurred in 43% of stroke pts <7 d. Onset of fever occurred in first 2 days in 64% of febrile patients.

Reith 1996[3]

Admission body temp is independently related to stroke severity, lesion size, mortality and outcome. [unclear how measured “outcome”; didn’t separate AIS from ICH]

Castillo 1998[9]

The relationship between the degree of hyperthermia and stroke outcome/FIV is strongest when it begins within 24 h of symptom onset.

Georgilis 1999[4]

Fever in stroke is assoc with ↑age, ↑severity, more invasive techniques, worse outcome. When fever present without focus of infection, it tends to occur earlier.

Wang 2000[12]

For ischaemic stroke, admission temp (time unspecified) was significant predictor of in-hospital mortality: for each 1° increase, OR ↑ by 3.9 (CI 1.9 to 7.8, p<0.001).

Boysen 2001[8]

Temp < 6 h post stroke onset has no prognostic influence on 3 month mRS. More severe strokes have higher temperature in first 48 h. [Also looked at ICH]. 7 d fatality rate higher in patients with lower body temp on admission.

Kammersgaard 2002[6]

For all strokes, a 1° difference in admission body temperature gives 30% increase in relative risk of 5 yr mortality. No association between admission temp and survival in pts still alive at 3 months.

Audebert 2004[13]

Larger stroke volume and greater NIHSS assoc with higher temp, CRP and WCC. Successful thrombolysis attenuates inflammatory response

Sulter 2004[1]

56% developed hyperthermia in 1st 48 h. Infectious cause found in 1/3 of patients.

Ernon 2006[14]

Hyperthermia relative to baseline in 24 h (post rtPA) is assoc with unfavourable outcome

Leira 2006[11]

Hyperthermia assoc with higher levels of proinflammatory markers. Inflammatory mediators play a role in acute ischaemic brain damage independently of hyperthermia

Wong 2007[15]

Mean temp rise in first 24 h from 36.5 to 36.7°, peak at 36 h. More severe strokes have higher temp rise.

Idicula 2008[16]

Body temp before thrombolysis was not assoc with 3 month outcome, but high temp thereafter was.

Millan 2008[17]

Body temp ≥37 at 24 h but not at baseline was assoc with lack of recanalisation, greater hyperdensity volume and worse functional outcome, regardless of stroke severity and time to treatment

Saini 2009[7]

Hyperthermia assoc with poor outcome. Delayed hyperthermia is more strongly assoc with poor outcomes than early hyperthermia. No association between baseline hyperthermia and outcome.

den Hertog (PAIS) 2009 & 2011[18, 19]

Baseline body temp was not related to improvement. Increased body temp at 24 h was associated with low likelihood of improvement.

Naess 2010[20]

High body temperature was associated with favorable short-term outcome in those who were thrombolysed vs. those not thrombolysed

Phipps 2011[21]

High “fever burden” (combination of fever height and duration) was associated with death or with referral to hospice

  1. d: days; AIS: acute ischemic stroke; ICH: intracerebral haemorrhage; FIV: final infarct volume; h: hours; OR: odds ratio; CI: confidence interval; mRS: modified Rankin Score; NIHSS: National Institutes of Health Stroke Scale; CRP: C reactive protein; WCC: white cell count; rtPA: recombinant tissue plasminogen activator.