Evaluating extreme temperature values and patient outcomes in aneurysmal subarachnoid hemorrhage: Post-hoc insights from the Earlydrain trial

Abstract

Purpose

Dysregulation of temperature in aneurysmal subarachnoid hemorrhage (aSAH) patients may worsen neurological outcomes. Fever and hypothermia could be related to infection, inflammation, or loss of central temperature control. However, longitudinal studies on temperature extremes and outcomes are lacking. This post-hoc analysis of the Earlydrain trial examines the prognostic significance of body temperature during the first 8 days of neurocritical care.

Methods

We analyzed data from 287 patients, using Generalized Estimating Equations to investigate clinically used thresholds for intervention on body temperature. Statistical models were adjusted for hemorrhage severity, age, intracerebral and intraventricular hemorrhage, infection and the use of a lumbar drainage. We assessed the impact of different temperature thresholds on the modified Rankin Scale (mRS) at 180 days and the incidence of secondary infarctions.

Results

Extreme temperatures were associated with worse 180-day outcomes. In univariate analysis, all investigated temperature thresholds (>38.0 °C, >38.2 °C, > 39.0 °C, as well as <36.0 °C) were associated with worse outcome. In multivariate analysis, temperatures above 39 °C and below 36 °C increased the odds of an unfavorable mRS >2 (OR_adj = 2.60, p = 0.002 and OR_adj = 3.82, p = 0.02, respectively). The development of secondary infarctions was not significantly related to temperature extremes.

Conclusion

Extreme temperature values significantly influence outcomes in aSAH. Maintaining normothermia may improve prognosis, warranting prospective studies for targeted temperature management.