Is higher body temperature beneficial in ischemic stroke patients with normal admission CT angiography of the cerebral arteries?
BACKGROUND
Low body temperature is considered beneficial in ischemic stroke due to neuroprotective mechanisms, yet some studies suggest that higher temperatures may improve clot lysis and outcomes in stroke patients treated with tissue plasminogen activator (tPA). The effect of increased body temperature in stroke patients treated with tPA and with normal computed tomography angiography (CTA) on admission is unknown. We hypothesized a beneficial effect of higher body temperature in the absence of visible clots on CTA, possibly due to enhanced lysis of small, peripheral clots.


METHODS
Patients with ischemic stroke admitted to our Stroke Unit between February 2006 and April 2013 were prospectively registered in a database (Bergen NORSTROKE Registry). Ischemic stroke patients treated with tPA with normal CTA of the cerebral arteries were included. Outcomes were assessed by the modified Rankin Scale (mRS) after 1 week. An excellent outcome was defined as mRS=0, and a favorable outcome as mRS=0-1.


RESULTS
A total of 172 patients were included, of which 48 (27.9%) had an admission body temperature ≥37.0°C, and 124 (72.1%) had a body temperature <37.0°C. Body temperature ≥37.0°C was independently associated with excellent outcomes (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.24-6.46; P=0.014) and favorable outcomes (OR: 2.8; 95% CI: 1.13-4.98; P=0.015) when adjusted for confounders.


CONCLUSIONS
We found an association between higher admission body temperature and improved outcome in tPA-treated stroke patients with normal admission CTA of the cerebral arteries. This may suggest a beneficial effect of higher body temperature on clot lysis in the absence of visible clots on CTA.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Christopher Elnan
CE
Kvistad
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Andrej
A
Khanevski
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Aliona
A
Nacu
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Lars
L
Thomassen
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Ulrike
U
Waje-Andreassen
Department of Neurology, Haukeland University Hospital, Bergen, Norway ; Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.
Halvor
H
Naess
D000368:Aged; D000369:Aged, 80 and over; D001833:Body Temperature Regulation; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
acute ischemic stroke; body temperature; thrombolysis; tissue plasminogen activator