title: A higher body temperature is associated with haemorrhagic transformation in patients with acute stroke untreated with recombinant tissue-type plasminogen activator (rtPA).
abstract: Higher body temperature is a prognostic factor of poor outcome in acute stroke. Our aim was to study the relationship between body temperature, HT (haemorrhagic transformation) and biomarkers of BBB (blood-brain barrier) damage in patients with acute ischaemic stroke untreated with rtPA (recombinant tissue-type plasminogen activator). We studied 229 patients with ischaemic stroke <12 h from symptom onset. Body temperature was determined at admission and every 6 h during the first 3 days. HT was evaluated according to ECASS II (second European Co-operative Acute Stroke Study) criteria in a multimodal MRI (magnetic resonance imaging) at 72 h. We found that 55 patients (34.1%) showed HT. HT was associated with cardioembolic stroke (64.2% against 23.0%; P<0.0001), higher body temperature during the first 24 h (36.9°C compared with 36.5°C; P<0.0001), more severe stroke [NIHSS (National Institutes of Health Stroke Scale) score, 14 (9-20) against 10 (7-15); P=0.002], and greater DWI (diffusion-weighted imaging) lesion volume at admission (23.2 cc compared with 13.2 cc; P<0.0001). Plasma MMP-9 (matrix metalloproteinase 9) (187.3 ng/ml compared with 44.2 ng/ml; P<0.0001) and cFn (cellular fibronectin) levels (16.3 μg/ml compared with 7.1 μg/ml; P=0.001) were higher in patients with HT. Body temperature within the first 24 h was independently associated with HT {OR (odds ratio), 7.3 [95% CI (confidence interval), 2.4-22.6]; P<0.0001} after adjustment for cardioembolic stroke subtype, baseline NIHSS score and DWI lesion volume. This effect remained unchanged after controlling for MMP-9 and cFn. In conclusion, high body temperature within the first 24 h after ischaemic stroke is a risk factor for HT in patients untreated with rtPA. This effect is independent of some biological signatures of BBB damage.
authors.affiliation: Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Leira
authors.forename: Tomás
authors.initials: T
authors.lastname: Sobrino
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanco
authors.forename: Francisco
authors.initials: F
authors.lastname: Campos
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Yáñez
authors.forename: Mar
authors.initials: M
authors.lastname: Castellanos
authors.forename: Octavio
authors.initials: O
authors.lastname: Moldes
authors.forename: Mónica
authors.initials: M
authors.lastname: Millán
authors.forename: Antoni
authors.initials: A
authors.lastname: Dávalos
authors.forename: José
authors.initials: J
authors.lastname: Castillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001812:Blood-Brain Barrier / Q000378:metabolism / Q000473:pathology; D001831:Body Temperature; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000097:blood / Q000378:metabolism / Q000503:physiopathology*; D005353:Fibronectins / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000235:genetics / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D005353:Fibronectins; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D020780:Matrix Metalloproteinase 9