title: Clinical predictors of fever in stroke patients: relevance of nasogastric tube.
abstract: OBJECTIVE
  Fever frequently occurs in stroke patients and worsens their prognosis. However, only few studies have assessed the determinants of fever in acute stroke, and no study has specifically addressed the possible prediction of the development of fever.
  
  
  METHODS
  This investigation included 536 patients with acute stroke and a body temperature <=37°C during the first 24 h of stay. Ninety-two of them (17.2%) subsequently developed fever (defined as a temperature >=37.5°C starting after 24 h). Among the clinical variables available during the first 24 h from admission, those predictive of the subsequent appearance of fever were searched for. One hundred further patients had a temperature >37°C during the first 24 h.
  
  
  RESULTS
  In univariate analysis, many variables were predictive of the subsequent development of fever, but in multivariate analysis, only the following four predictors remained significant (odds ratio [95% confidence interval], P value): nasogastric tube (4.0 [2.2-7.4], <0.0001), atrial fibrillation (2.3 [1.4-3.8], 0.001), total anterior circulation syndrome (2.0 [1.2-3.5], 0.01), and urinary catheter (1.9 [1.1-3.3], 0.01). Among the 52 (9.7%) patients with three or four predictors, 31 (59.6%) subsequently developed fever. In addition, the factors independently associated with a temperature >37°C during the first 24 h were as follows: National Institutes of Health Stroke Scale (P < 0.0001), hemorrhagic stroke (P = 0.0008), atrial fibrillation (P = 0.002), and total parenteral nutrition (P = 0.03).
  
  
  CONCLUSIONS
  In patients with acute stroke, four clinical variables were found to be independently associated with the risk of developing fever and, of them, nasogastric tube was the strongest and most significant one.
authors.affiliation: Stroke Unit-Medical Department of Continuity of Care and Disability, S.Orsola-Malpighi Hospital, Bologna, Italy.|Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Muscari
authors.affiliation: Stroke Unit-Medical Department of Continuity of Care and Disability, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Puddu
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Conte
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Falcone
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Kolce
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: M V
authors.initials: MV
authors.lastname: Lega
authors.affiliation: Stroke Unit-Medical Department of Continuity of Care and Disability, S.Orsola-Malpighi Hospital, Bologna, Italy.|Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000368:Aged; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D014481:United States
keywords: determinants; fever; nasogastric tube; risk factors; stroke