BODY-TEMPERATURE IN ACUTE STROKE - RELATION TO STROKE SEVERITY, INFARCT SIZE, MORTALITY, AND OUTCOME

Background In laboratory animals, cerebral ischaemia is worsened by hy perthermia and improved by hypothermia. Whether these observations app ly to human beings with stroke is unknown. We therefore examined the r elation between body temperature on admission with acute stroke and va rious indices of stroke severity and outcome. Methods In a prospective and consecutive study 390 stroke patients were admitted to hospital w ithin 6 h after stroke (median 2.4 h). We determined body temperature on admission, initial stroke severity, infarct size, mortality, and ou tcome in survivors. Stroke severity was measured on admission, weekly, and at discharge on the Scandinavian Stroke Scale (SSS). Infarct size was determined by computed tomography. Multiple logistic and linear r egression outcome analyses included relevant confounders and potential predictors such as age, gender, stroke severity on admission, body te mperature, infections, leucocytosis, diabetes, hypertension, atrial fi brillation, ischaemic heart disease, smoking, previous stroke, and com orbidity. Findings Mortality was lower and outcome better in patients with mild hypothermia on admission; both were worse in patients with h yperthermia. Body temperature was independently related to initial str oke severity (p<0.009), infarct size (p<0.0001), mortality (p<0.02), a nd outcome in survivors (SSS at discharge) (p<0.003). For each 1 degre es C increase in body temperature the relative risk of poor outcome (d eath or SSS score on discharge <30 points) rose by 2.2 (95% CI 1.4-3.5 ) (p<0.002). Interpretation We have shown that, in acute human stroke, an association exists between body temperature and initial stroke sev erity, infarct size, mortality, and outcome. Only intervention trials of hypothermic treatment can prove whether this relation is causal.