Postoperative fever and clinical outcomes after endoscopic surgery for spontaneous intracerebral hemorrhage: a retrospective database study.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY BMC Neurology Pub Date : 2024-10-15 DOI:10.1186/s12883-024-03898-4
Shuang Liu, Yunjian Zhang, Shengyang Su, Jirao Ren, Jinyong Long, Shikui Cao, Fuhua Li, Zihui Gao, Deqiang Wang, Xiaobiao Zhang
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Abstract

Background: Spontaneous intracerebral hemorrhage (SICH) is a severe stroke with high mortality and disability rates. Endoscopic surgery is an increasingly widely used minimally invasive method for the treatment of SICH. However, the impact of fever on patient outcomes remains unclear.

Methods: We retrospectively included patients aged 18 years or older with supratentorial SICH confirmed by CT, who underwent endoscopic hematoma evacuation within 48 h of symptom onset. The primary outcome was the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included hospital and neurosurgical intensive care unit (NSICU) stays, and perioperative complications. We analyzed the association between postoperative fever (highest temperature within 24 h after surgery) and these outcomes using multivariate analysis, generalized additive models, and segmented regression analysis.

Results: Of the 56 patients, 38 had favorable outcomes (mRS ≤ 3) and 18 had unfavorable outcomes (mRS > 3) at 3 months. A threshold effect at 38.2 °C was observed between postoperative body temperature and clinical outcomes. The mean age was 56 years (SD = 9) for the > 38.2 °C group and 58 years (SD = 8) for the ≤ 38.2 °C group, with a similar proportion of male patients (63% vs. 69%, P = 0.635). Patients with postoperative fever had larger hematoma volumes (65 vs. 56 mL; P = 0.008). Other characteristics were similar between the groups. Postoperative fever (> 38.2 °C) was independently associated with a 4.99-fold increased risk of unfavorable outcomes (95% CI = [1.13 to 25.90]; P = 0.040), which remained significant after excluding patients with postoperative complications (adjusted RR = 16.03, 95% CI = [1.69 to 417.24]; P = 0.033). The association was consistent across subgroups with different Glasgow Coma Scale scores, hematoma volumes, and intraventricular extension. Postoperative fever was also associated with longer NSICU stays (3.1 vs. 2.3 days; P = 0.023), longer hospital stays (17.2 vs. 13.6 days; P = 0.010), more residual hematoma, and greater edema volume. Different antipyretic therapies did not affect outcomes.

Conclusions: This study identifies a temperature threshold (38.2 °C) associated with poor outcomes in SICH patients undergoing endoscopic surgery. Further research is needed to mitigate postoperative fever and improve patient outcomes.

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自发性脑内出血内窥镜手术后发热与临床预后:一项回顾性数据库研究。
背景:自发性脑内出血(SICH)是一种死亡率和致残率都很高的严重中风。内镜手术是治疗 SICH 的一种日益广泛应用的微创方法。然而,发热对患者预后的影响仍不明确:我们回顾性地纳入了经 CT 证实为脑室上 SICH 的 18 岁或以上患者,这些患者在症状出现 48 小时内接受了内镜下血肿清除术。主要结果是3个月后的改良Rankin量表(mRS)评分。次要结果包括住院时间、神经外科重症监护室(NSICU)住院时间和围手术期并发症。我们采用多变量分析、广义相加模型和分段回归分析等方法分析了术后发热(术后24小时内的最高体温)与这些结果之间的关系:结果:在 56 名患者中,38 人在 3 个月后获得了良好的预后(mRS ≤ 3),18 人获得了不良预后(mRS > 3)。术后体温 38.2 °C与临床结果之间存在阈值效应。体温>38.2 °C组的平均年龄为56岁(SD = 9),体温≤38.2 °C组的平均年龄为58岁(SD = 8),男性患者的比例相似(63%对69%,P = 0.635)。术后发烧患者的血肿体积更大(65 mL 对 56 mL;P = 0.008)。两组患者的其他特征相似。术后发热(> 38.2 °C)与不利预后风险增加 4.99 倍(95% CI = [1.13 至 25.90];P = 0.040)独立相关,排除术后并发症患者后,该风险仍然显著(调整后 RR = 16.03,95% CI = [1.69 至 417.24];P = 0.033)。在格拉斯哥昏迷量表评分、血肿体积和脑室内扩展程度不同的亚组中,这种关联是一致的。术后发热还与NSICU住院时间延长(3.1天 vs. 2.3天;P = 0.023)、住院时间延长(17.2天 vs. 13.6天;P = 0.010)、残留血肿增多和水肿体积增大有关。不同的退热疗法对结果没有影响:这项研究确定了与接受内镜手术的 SICH 患者不良预后相关的体温阈值(38.2 °C)。需要进一步研究如何减轻术后发热并改善患者预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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