Relationship Between Body Temperature In Acute Stage Of Stroke And Prognosis

Objective: 1 .To observe the change of body temperature in acute stage of stroke.2.To evaluate the factors associated with body temperature in acute stage of stroke. 3.To evaluate the relationship between body temperature in acute stage of stroke and death/disability.Materials and methods:1.The consecutive cases of stroke were prospectively registered in the neurological wards of the West China Hospital,Sichuan University from Mar 1,2002 to Mar 1,2004,of which only the patients within 6 hours from stroke onset were included in the study.Body temperature was taken no less than 4 times everyday for 5 days from stroke onset and other clinical characteristics related to outcomes were collected.The outcomes were followed up at the end of 1~st,3~rd,6~th and 12~th month post ictus. 2.Body temperature curve of median temperature of the highest temperature in each 12-hour period from the onset of stroke was taken to evaluate the change of temperature.3.Fever was defined as temperature ≥37.3 ℃. Fever within 5 days from stroke onset was analyzed in relation to infection,stroke type ,stroke severity ,etc by using univariateand multivariate logistical regression to evaluate the factors associated with temperature in acute stage of stroke. 4.Outcomes were analyzed in relation to body temperature(fever on admission and fever of each day within 5 days after onset of stroke )and other clinical characteristics(infection, Level of consciousness and degree of neurologic impairment ,etc.)by using univareate logistical regression.Multivariate logistical regression was applied to detect the predictors of outcomes.Results:Two hundred and eighty-four cases of ischemic and hemorrhagic stroke within 6 hour from onset were included. 1 .Body temperature rised in 24-hour after stoke onset ,maintaining high level with the highest median temperature 37. 0°C 12-60 hour and falling after 60-hour. Subgroup analysis showed: in severe stroke patients, temperature rised in 24-hour after onset ,however in mild to moderate stroke ,there was no significant rise in temperature. 2. The factors associated with body temperature in acute stage of stroke were infection,stroke severity and stroke type. 3. 190 patients(67%)had fever within 5 days from onset.The l-month,3-month fatality rates were 30%,36%,and l-month,3-month death/disabitity rates were 72%,62% of patients with fever. The l-month,3-month fatality rates were 12%,14%,and l-month,3 -month death/disabitity rates were 36%,31% of patients without fever. The difference of death and death/disability between two groups is significant. Prognosis of patients with fever was worse than patients with normal body temperature AFever on admission and fever in 1st day after onset was not related to prognosis(death, death/disability at the end of 1st and 3rd month).Fever in 2nd,3rd,4th day was related to death at the end of 1st and 3 rd month. Fever in 2nd day was also related to death/disability at theend of 1st and 3r month.Relationship between body temperature and outcomes at the end of 6th, 12th month will be evaluated when the follow-ups for all cases are completed.Conclusion: 1. Body temperature rised in 24-hour after stoke onset maintaining high level with the highest median temperature 37. 0°C in 12-60 hour and falling after 60-hour. Subgroup analysis showed: in severe stroke patients, temperature rised in 24-hour after onset ,however in mild to moderate stroke ,there was no significant rise in temperature.2. The factors associated with body temperature in acute stage of stroke were infection,stroke severity and stroke type . 3.The risk of death at the end of lst,3rd month was high in patients with fever in 2nd,3rd,4th day after stroke onset and the risk of death/disability was also high in patients with fever in 2nd day.This study suggested that fever in a few days after stroke onset should be decreased actively and body temperature should be maintained in a normothermic range at least.