Clinical short communicationPrognostic significance of early pyrexia in acute intracerebral haemorrhage: The INTERACT2 study
Introduction
Acute spontaneous intracerebral haemorrhage (ICH) is the most serious type of stroke, with high mortality and disability [1]. Pyrexia occurs in 30–40% of ICH patients, in relation to infection and central mechanisms [2]. Preclinical studies in acute ischaemic stroke have shown that high body temperature is associated with large infarcts and higher mortality [[3], [4], [5]], while in ICH it predicts high mortality, greater haematoma growth and residual disability [[6], [7], [8], [9]]. A retrospective study of 251 patients with spontaneous ICH admitted within 24 h of onset and body temperature measured on admission and during the first 72 h found that elevated body temperature independently predicted poor functional outcome [6], which lends support for an immune-inflammatory reaction to perihaematomal oedema [10]. We aimed to determine associations of early elevation in body temperature on key clinical and imaging outcomes in ICH patients who participated in the main phase of the international Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2) [11].
Section snippets
Study design and participants
The INTERACT2 study was a multicentre, prospective, open, blinded outcome assessed, randomised controlled trial in which the efficacy of intensive (target systolic blood pressure (SBP) <140 mmHg within 1 h and maintained for 7 days) was compared with contemporaneous guideline-recommended (<180 mmHg) BP management in patients with spontaneous ICH (<6 h) with elevated SBP (150–220 mmHg) [11]. Written informed consent was obtained from each participant or their legal surrogate. The study protocol
Results
In 2829 INTERACT2 participants, there were 2792 (98.7%) with admission body temperature and 90-day clinical outcomes data, including 966 (34.1%) with baseline and 24-h CT scans, available for analyses (Supplemental fig. A.1, online only). Overall, there were 39 (1.4%) patients with baseline elevated body temperature within 6 h of ICH onset. Table 1 shows that patients with baseline elevated body temperature had higher heart rate, leucocyte count, NIHSS scores, lower GCS scores, and more IVH and
Discussion
In these post-hoc analyses of the INTERACT2 dataset, we have shown that an early elevation in body temperature after the onset of spontaneous ICH was associated with higher mortality, and larger PHE volume at baseline and 24 h.
Our results are consistent with other studies showing associations between pyrexia and poor outcomes in ischaemic and mixed stroke patients [7, 13], and with exacerbated neuronal damage and cerebral oedema in all forms of brain injury induced by temperature elevation [6,15
Funding
INTERACT2 was supported by program (571281) and project grant (512402 and 1004170) from the National Health and Medical Research Council (NHMRC) of Australia.
Declarations of interest
Dr. Anderson reports receiving grants, speaker fees and travel reimbursement from Takeda China. AM, SJ, CD, and DZ report no conflict of interest.
Acknowledgements
None.
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