title: Delayed Fever and Neurological Outcome after Cardiac Arrest: A Retrospective Clinical Study.
abstract: BACKGROUND
  The aim of this study was to evaluate the association between fever after the first days of ICU stay and neurological outcome after cardiac arrest (CA).
  
  
  METHODS
  We retrospectively analyzed CA patients admitted to intensive care unit (ICU).
  
  
  METHODS
  age ≥18 years, Glasgow Coma Scale score ≤8 at ICU admission and assessment of body core temperature (BCT) using bladder or intravascular probes.
  
  
  METHODS
  ICU length of stay (LOS) <3 days and pregnancy. The primary endpoint was neurological outcome assessed with Cerebral Performance Category (CPC) scale 6 months after CA.
  
  
  RESULTS
  One hundred thirty-two patients were analyzed. Fever was present in 105 (79.6%) patients. Variables associated with unfavorable outcome were (1) older age (p < 0.0025); (2) non-shockable cardiac rhythms (p < 0.0001); (3) higher Simplified Acute Physiology Score (SAPS) II (p < 0.0001); (4) pupillary abnormalities at ICU admission (p < 0.018); and (5) elevated degree of maximal BCT (Tmax) during ICU stay (p < 0.046). After multivariate analysis, Tmax maintained a significant relationship with neurological outcome. An increase of 1 °C in Tmax during ICU stay decreased the odds ratio for a favorable outcome by a factor of 31% (p < 0.001). Moreover, we discovered a significant interaction between the day of Tmax (t-Tmax) and Tmax (p = 0.004); the later Tmax occurs, the more deleterious effects are observed on outcome.
  
  
  CONCLUSIONS
  Fever is frequent after CA, and Tmax in ICU is associated with worsened neurological outcome. This association becomes stronger as the timing of Tmax extends further from the CA.
authors.affiliation: Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Parma, Italy. edoardopicetti@hotmail.com.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Picetti
authors.affiliation: Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
authors.forename: Marta Velia
authors.initials: MV
authors.lastname: Antonini
authors.affiliation: Scuola di Specializzazione in Neurologia, Università degli Studi di Parma, Parma, Italy.
authors.forename: Yerma
authors.initials: Y
authors.lastname: Bartolini
authors.affiliation: Scuola di Specializzazione in Anestesia e Rianimazione, Università degli Studi di Parma, Parma, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: DeAngelis
authors.affiliation: Scuola di Specializzazione in Neurologia, Università degli Studi di Parma, Parma, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Delaj
authors.affiliation: Unità Operativa di Neurologia, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Florindo
authors.affiliation: Scuola di Specializzazione in Anestesia e Rianimazione, Università degli Studi di Parma, Parma, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Villani
authors.affiliation: Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Caspani
mesh_terms: D000368:Aged; D005260:Female; D005334:Fever / Q000209:etiology*; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cardiac arrest; Fever; Intensive care unit; Neurological outcome; Temperature management