Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest

作者：Bro Jeppesen John^*; Hassager Christian; Wanscher Michael; Soholm Helle; Thomsen Jakob H; Lippert Freddy K; Moller Jacob E; Kober Lars; Kjaergaard Jesper

来源：Resuscitation, 2013, 84(12): 1734-1740.

DOI：10.1016/j.resuscitation.2013.07.023

• Out-of-hospital cardiac arrest
• Therapeutic hypothermia
• Mortality
• Neurological outcome
• Fever

Objective: Post-cardiac arrest fever has been associated with adverse outcome before implementation of therapeutic hypothermia (TH), however the prognostic implications of post-hypothermia fever (PHF) in the era of modern post-resuscitation care including TH has not been thoroughly investigated.
The aim of the study was to assess the prognostic implication of PHF in a large consecutive cohort of comatose survivors after out-of-hospital cardiac arrest (OHCA) treated with TH.
Methods: In the period 2004-2010, a total of 270 patients resuscitated after OHCA and surviving a 24-h protocol of TH with a target temperature of 32-34 degrees C were included. The population was stratified in two groups by median peak temperature (>= 38.5 degrees C) within 36 h after rewarming: PHF and no-PHF. Primary endpoint was 30-days mortality and secondary endpoint was neurological outcome assessed by Cerebral Performance Category (CPC) at hospital discharge.
Results: PHF (>38.5 degrees C)was associated with a 36% 30-days mortality rate compared to 22% in patients without PHF, p(log-rank) = 0.02, corresponding to an adjusted hazard rate (HR) of 1.8 (95% CI: 1.1-2.7), p = 0.02). The maximum temperature (HR = 2.0 per degrees C above 36.5 degrees C (95% CI: 1.4-3.0), p = 0.0005) and the duration of PHF (HR = 1.6 per 8 h (95% CI: 1.3-2.0), p < 0.0001) were also independent predictors of 30-days mortality in multivariable models. Good neurological outcome (CPC1-2) versus unfavourable outcome (CPC3-5) at hospital discharge was found in 61% vs. 39% in the PHF group compared to 75% vs. 25% in the No PHF group, p = 0.02.
Conclusions: Post-hypothermia fever >= 38.5 degrees C is associated with increased 30-days mortality, even after controlling for potential confounding factors. Avoidance of PHF as a therapeutic target should be evaluated in prospective randomized trials.

• 出版日期2013-12