title: Brain injury as a risk factor for fever upon admission to the intensive care unit and association with in-hospital case fatality: a matched cohort study.
abstract: OBJECTIVE
  To test the hypothesis that fever was more frequent in critically ill patients with brain injury when compared to nonneurological patients and to study its effect on in-hospital case fatality.
  
  
  METHODS
  Retrospective matched cohort study utilizing a single-center prospectively compiled registry. Critically ill neurological patients ≥18 years and consecutively admitted to the intensive care unit (ICU) with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI) were selected. Patients were matched by sex, age, and Acute Physiology and Chronic Health Evaluation II (APACHE-II) to a cohort of nonneurological patients. Fever was defined as any temperature ≥37.5°C within the first 24 hours upon admission to the ICU. The primary outcome measure was in-hospital case fatality.
  
  
  RESULTS
  Mean age among neurological patients was 65.6 ± 15 years, 46% were men, and median APACHE-II was 15 (interquartile range 11-20). There were 18% AIS, 27% ICH, and 6% TBI. More neurological patients experienced fever than nonneurological patients (59% vs 47%, P = .007). The mean hospital length of stay was higher for nonneurological patients (18 ± 20 vs 14 ± 15 days, P = .007), and more neurological patients were dead at hospital discharge (29% vs 20%, P < .0001). After risk factor adjustment, diagnosis (neurological vs nonneurological), and the probability of being exposed to fever (propensity score), the following variables were associated with higher in-hospital case fatality: APACHE-II, neurological diagnosis, mean arterial pressure, cardiovascular and respiratory dysfunction in ICU, and fever (odds ratio 1.9, 95% confidence interval 1.04-3.6, P = .04).
  
  
  CONCLUSIONS
  These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality.
authors.affiliation: Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA fred.rincon@jefferson.edu.
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.affiliation: Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA.
authors.forename: Utkal
authors.initials: U
authors.lastname: Patel
authors.affiliation: Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA.
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.affiliation: Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Ross
authors.affiliation: Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA.
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.affiliation: Department of Medicine, Division of Critical Care and Cardiovascular Medicine, Robert Wood Johnson Medical School, Cooper University Hospital, UMDNJ, Camden, NJ, USA.
authors.forename: Sergio
authors.initials: S
authors.lastname: Zanotti-Cavazzoni
mesh_terms: D000368:Aged; D001831:Body Temperature; D001930:Brain Injuries / Q000401:mortality* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology; D016896:Treatment Outcome
keywords: fever; intracerebral hemorrhage; stroke; traumatic brain injury