Hyperthermia in human ischemic and hemorrhagic stroke: similar outcome, different mechanisms.
Hyperthermia is a predictor of poor outcome in ischemic (IS) and intracerebral hemorrhagic (ICH) stroke. Our aim was to study the plausible mechanisms involved in the poor outcome associated to hyperthermia in stroke. We conducted a case-control study including patients with IS (n = 100) and ICH (n = 100) within the first 12 hours from symptom onset. Specifically, IS and ICH patients were consecutively included into 2 subgroups, according to the highest body temperature within the first 24 hours: Tmax <37.5°C and Tmax ≥37.5°C, up to reach 50 patients per subgroup of temperature for both IS and ICH patients. Body temperature was determined at admission and every 4 hours during the first 48 hours. Main outcome variable was poor functional outcome (modified Rankin scale score >2) at 3 months. Serum levels of glutamate and active MMP-9 were measured at admission. Our results showed that Tmax ≥37.5°C within the first 24 hours was independently associated with poor outcome in both IS (OR, 12.43; 95% CI, 3.73-41.48; p<0.0001) and ICH (OR, 4.29; 95% CI, 1.32-13.91; p = 0.015) after adjusting for variables with a proven biological relevance for outcome. However, when molecular markers levels were included in the logistic regression model, we observed that glutamate (OR, 1.01; 95% CI, 1.00-1.02; p = 0.001) and infarct volume (OR, 1.06; 95% CI, 1.01-1.10; p = 0.015) were the only variables independently associated to poor outcome in IS, and active MMP-9 (OR, 1.04; 95% CI, 1.00-1.08; p = 0.002) and National Institute of Health Stroke Scale (NIHSS) at admission (OR, 1.29; 95% CI, 1.13-1.49; p<0.0001) in ICH. In conclusion, these results suggest that although the outcome associated to hyperthermia is similar in human IS and ICH, the underlying mechanisms may be different.
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain.
Francisco
F
Campos
Tomás
T
Sobrino
Alba
A
Vieites-Prado
María
M
Pérez-Mato
Manuel
M
Rodríguez-Yáñez
Miguel
M
Blanco
José
J
Castillo
D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D002545:Brain Ischemia / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D005334:Fever / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D018698:Glutamic Acid / Q000097:blood; D006801:Humans; D016015:Logistic Models; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*
D018698:Glutamic Acid; D020780:Matrix Metalloproteinase 9