Impact of fever on the outcome non-anoxic acute brain injury patients: a systematic review and meta-analysis

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE Critical Care Pub Date : 2024-11-13 DOI:10.1186/s13054-024-05132-6

Elisa Gouvêa Bogossian, Michele Salvagno, Marco Fiore, Marta Talamonti, Chiara Prezioso, Federica Montanaro, Sara Fratino, Sophie Schuind, Fabio Silvio Taccone

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Abstract

Fever is a common condition in intensive care unit (ICU) patients, with an incidence between 30 and 50% in non-neurological ICU patients and up to 70–90% in neurological ICU patients. We aim to perform systematic review and meta-analysis of current literature to assess impact of fever on neurological outcomes and mortality of acute brain injury patients. We searched PubMed/Medline, Scopus and Embase databases following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and we included both retrospective and prospective observational studies, interventional studies, and randomized clinical trials that had data on body temperature and fever during ICU admission. The primary endpoints were neurological outcome and mortality at any time. Secondary outcomes included: early neurological deterioration, delayed cerebral ischemia (DCI, only for patients with subarachnoid hemorrhage), large infarct or hemorrhage size, hemorrhagic transformation (only for patients with ischemic stroke). This study was registered in PROSPERO (CRD42020155903). 180 studies from 14692 records identified after the initial search were included in the final analysis, for a total of 460,825 patients. Fever was associated with an increased probability of unfavorable neurological outcome (pooled OR 2.37 [95% CI 2.08–2.71], I2:92%), death (pooled OR 1.31 [95% CI 1.28–1.34], I2:93%), neurological deterioration (pooled OR 1.10 [95% CI 1.05–1.15]), risk of DCI (pooled OR 1.96 [95% CI 1.73–2.22]), large infarct size (pooled OR 2.94 [95% CI 2.90–2.98]) and hemorrhagic transformation (pooled OR 1.63 [95% CI 1.34–1.97]) and large hemorrhagic volume (pooled OR 2.38 [95% CI 1.94–2.93]). Fever was associated with poor neurological outcomes and mortality in patients with acute brain injury. Whether normothermia should be targeted in the management of all neuro critically ill patients warrants specific research.

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发烧对无缺氧急性脑损伤患者预后的影响：系统回顾和荟萃分析

发热是重症监护病房（ICU）患者的常见病，非神经重症监护病房患者的发热发生率在 30-50% 之间，而神经重症监护病房患者的发热发生率高达 70-90%。我们旨在对现有文献进行系统回顾和荟萃分析，以评估发热对急性脑损伤患者神经系统预后和死亡率的影响。我们按照《系统综述和荟萃分析首选报告项目》的建议检索了 PubMed/Medline、Scopus 和 Embase 数据库，并纳入了有 ICU 入院期间体温和发热数据的回顾性和前瞻性观察研究、干预研究和随机临床试验。主要研究终点是神经系统预后和任何时间的死亡率。次要结局包括：早期神经功能恶化、延迟性脑缺血（DCI，仅适用于蛛网膜下腔出血患者）、大面积梗死或出血、出血转化（仅适用于缺血性中风患者）。本研究已在 PROSPERO 登记（CRD42020155903）。初步搜索后从 14692 份记录中发现的 180 项研究被纳入最终分析，共计 460,825 名患者。发热与神经系统不良预后（汇总 OR 2.37 [95% CI 2.08-2.71]，I2:92%）、死亡（汇总 OR 1.31 [95% CI 1.28-1.34]，I2:93%）、神经系统恶化（汇总 OR 1.10 [95% CI 1.05-1.15]）、DCI 风险（汇总 OR 1.10 [95% CI 1.08-2.71]，I2:92%）的概率增加有关。15]）、DCI风险（汇总OR 1.96 [95% CI 1.73-2.22]）、大面积梗死（汇总OR 2.94 [95% CI 2.90-2.98]）和出血转化（汇总OR 1.63 [95% CI 1.34-1.97]）以及大出血量（汇总OR 2.38 [95% CI 1.94-2.93]）。发热与急性脑损伤患者的神经功能预后差和死亡率有关。在对所有神经重症患者进行管理时，是否应将正常体温作为目标，还需要进行具体研究。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.