Objective To evaluate fever burden as an independent predictor for prognosis of traumatic brain injury (TBI). Methods This retrospective study involved 355 TBI patients with Glasgow Coma Scale (GCS) ≤14, who presented at the emergency department of our hospital between November 2010 and October 2012. At 6 months follow-up, patients were divided into 5 groups based on Glasgow Outcome Scale (GOS) and dichotomized to GOS score (high (4 to 5) vs. low (1 to 3)). The relationship between fever burden and GOS was assessed. Results Fever burden increased as GOS scores decreased from 5 to 2, except for score 1 of GOS, which corresponded to a significant lower fever burden. Following dichotomization, patients in the high GOS group were younger, and showed less abnormal pupil reactivity (P<0.001), a higher median GCS score (P<0.001), and a lower median fever burden (P<0.001), compared with patients in the low GOS group. Univariate logistic regression analysis revealed that poor TBI prognosis was related to age, GCS, pupil reactivity, and fever burden (OR: 1.166 [95% CI: 1.117–1.217] P<0.0001). Multivariate logistic regression analysis identified fever burden as an independent predictor of poor prognosis after TBI (OR 1.098; 95% CI: 1.031–1.169; P = 0.003). These observations were confirmed by evaluation of the receiver operating characteristic (ROC) curve for fever burden (area under the curve [AUC] 0.73 [95% CI: 0.663–0.760]). Conclusion Fever burden might be an independent predictor for prognosis of TBI. High fever burden in the early stage of the disease course associated with TBI could increase the risk of poor prognosis.
References
[1]
Perel P, Edwards P, Wentz R, Roberts I (2006) Systematic review of prognostic models in traumatic brain injury. BMC Med Inform Decis Mak 6: 38. doi: 10.1186/1472-6947-6-38
[2]
Maas AI, Marmarou A, Murray GD, Teasdale SG, Steyerberg EW (2007) Prognosis and clinical trial design in traumatic brain injury: the IMPACT study. J Neurotrauma 24: 232–238. doi: 10.1089/neu.2006.0024
[3]
Roozenbeek B, Chiu YL, Lingsma HF, Gerber LM, Steyerberg EW, et al. (2012) Predicting 14-day mortality after severe traumatic brain injury: application of the IMPACT models in the brain trauma foundation TBI-trac(R) New York State database. J Neurotrauma 29: 1306–1312. doi: 10.1089/neu.2011.1988
[4]
Czeiter E, Mondello S, Kovacs N, Sandor J, Gabrielli A, et al. (2012) Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator. J Neurotrauma 29: 1770–1778. doi: 10.1089/neu.2011.2127
[5]
Lingsma HF, Roozenbeek B, Steyerberg EW, Murray GD, Maas AI (2010) Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol 9: 543–554. doi: 10.1016/s1474-4422(10)70065-x
[6]
Mayer SA, Kowalski RG, Presciutti M, Ostapkovich ND, McGann E, et al. (2004) Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med 32: 2508–2515. doi: 10.1097/01.ccm.0000147441.39670.37
[7]
Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC (2008) Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke 39: 3029–3035. doi: 10.1161/strokeaha.108.521583
[8]
Puccio AM, Fischer MR, Jankowitz BT, Yonas H, Darby JM, et al. (2009) Induced normothermia attenuates intracranial hypertension and reduces fever burden after severe traumatic brain injury. Neurocrit Care 11: 82–87. doi: 10.1007/s12028-009-9213-0
[9]
Diringer MN, Reaven NL, Funk SE, Uman GC (2004) Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients. Crit Care Med 32: 1489–1495. doi: 10.1097/01.ccm.0000129484.61912.84
[10]
Naidech AM, Bendok BR, Bernstein RA, Alberts MJ, Batjer HH, et al. (2008) Fever burden and functional recovery after subarachnoid hemorrhage. Neurosurgery 63: 212–217 discussion 217–218. doi: 10.1227/01.neu.0000320453.61270.0f
[11]
Phipps MS, Desai RA, Wira C, Bravata DM (2011) Epidemiology and outcomes of fever burden among patients with acute ischemic stroke. Stroke 42: 3357–3362. doi: 10.1161/strokeaha.111.621425
[12]
Marmarou A, Lu J, Butcher I, McHugh GS, Mushkudiani NA, et al. (2007) IMPACT database of traumatic brain injury: design and description. J Neurotrauma 24: 239–250. doi: 10.1089/neu.2006.0036
[13]
Collaborators MCT, Perel P, Arango M, Clayton T, Edwards P, et al. (2008) Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 336: 425–429. doi: 10.1136/bmj.39461.643438.25
[14]
Senathi-Raja D, Ponsford J, Schonberger M (2010) Impact of age on long-term cognitive function after traumatic brain injury. Neuropsychology 24: 336–344. doi: 10.1037/a0018239
[15]
Jiang JY, Gao GY, Li WP, Yu MK, Zhu C (2002) Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 19: 869–874. doi: 10.1089/08977150260190456
[16]
Mushkudiani NA, Engel DC, Steyerberg EW, Butcher I, Lu J, et al. (2007) Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 24: 259–269. doi: 10.1089/neu.2006.0028
[17]
Tokutomi T, Miyagi T, Ogawa T, Ono J, Kawamata T, et al. (2008) Age-associated increases in poor outcomes after traumatic brain injury: a report from the Japan Neurotrauma Data Bank. J Neurotrauma 25: 1407–1414. doi: 10.1089/neu.2008.0577
[18]
Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84. doi: 10.1016/s0140-6736(74)91639-0
[19]
Marmarou A, Lu J, Butcher I, McHugh GS, Murray GD, et al. (2007) Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma 24: 270–280. doi: 10.1089/neu.2006.0029
[20]
Reith J, Jorgensen HS, Pedersen PM, Nakayama H, Raaschou HO, et al. (1996) Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 347: 422–425. doi: 10.1016/s0140-6736(96)90008-2
[21]
Diringer MN, Neurocritical Care Fever Reduction Trial G (2004) Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 32: 559–564. doi: 10.1097/01.ccm.0000108868.97433.3f
