Factors related to the occurrence of hyperthermia in patients with acute ischaemic stroke and with primary intracerebral haemorrhage

Abstract

Background and purpose: Hyperthermia worsens prognosis in ischaemic, but probably not in haemorrhagic stroke. The reason for this discrepancy is unknown; therefore we designed this study to compare factors related to the occurrence of hyperthermia in patients with ischaemic and haemorrhagic stroke.

Material and methods: We studied 100 consecutive patients with hemispheric intracerebral haemorrhage and 100 patients with hemispheric ischaemic stroke, who were strictly matched regarding sex (53% were men), age (mean: 67+/-10 years) and severity of neurological deficit on admission according to the Scandinavian Stroke Scale [median: 22 (8-34)]. Body temperature was measured on admission and every 4 hours within the first 48 hours after admission. We recorded neurological deficit, disorders of consciousness, major infectious complications, and a range of routine biochemical markers. Outcome was assessed by 30-day mortality and by the functional status of survivors 30 and 90 days after stroke.

Results: The percentages of patients with hyperthermia (> 37.5 degrees C) were similar in ischaemic and haemorrhagic stroke (26% vs. 33% on day 1 and 19% vs. 23% on day 2, respectively). Patients with hyperthermia on day 1 in both groups had higher 30-day mortality, worse functional status after 90 days and more often had decreased consciousness on admission. Markers of inflammation were slightly higher in hyperthermic patients with ischaemic, but not with haemorrhagic stroke.

Conclusions: Hyperthermia in acute stroke, whether ischaemic or haemorrhagic, is associated with worse prognosis. Ischaemic stroke patients with hyperthermia have slightly increased levels of inflammatory markers when compared to patients without hyperthermia, but the same difference was not found in patients with haemorrhagic stroke.