Research Reports - Fever burden is an independent predictor for prognosis of traumatic brain injury

PLoS One. 2014 Mar 13;9(3)

Bao L, Chen D, Ding L, Ling W, Xu F

BJECTIVE: 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.

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