Predictive Factors of Fever After Aneurysmal Subarachnoid Hemorrhage and Its Impact on Delayed Cerebral Ischemia and Clinical Outcomes

Abstract

Objective Fever is relatively common and worsens neurologic injury after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to display the time course of body temperature, identify predictive factors of fever after SAH, and evaluate its impact on delayed cerebral ischemia (DCI) and clinical outcomes.

Methods Four hundred twelve patients with SAH and ruptured aneurysms who were treated at our institution between January 2007 and December 2016 were analyzed retrospectively. The febrile group was defined as patients having a maximal temperature ≥38.0°C for 2 consecutive days or for more than 3 days within 2 weeks after SAH, and the remaining patients comprised the afebrile group. The impact of fever on DCI and clinical outcomes was assessed.

Results Anterior communicating artery aneurysm, Hunt and Hess grade, SAH sum score, intraventricular hemorrhage sum score, and body mass index were independent predictive factors for fever after SAH. A larger SAH and fever were independent risk factors for DCI. A worse Hunt and Hess grade, concomitant intracerebral hemorrhage, DCI, old age, and fever were independent risk factors for unfavorable outcomes.

Conclusions Predictors of fever after SAH were a worse clinical status at admission, larger SAH and intraventricular hemorrhage, anterior communicating artery aneurysm, and greater body mass index. Fever itself was an independent risk factor for DCI and unfavorable outcomes after aneurysmal SAH.