Abstract
Although hyperthermia is associated with poor outcomes in ischaemic stroke (IS), some studies indicate that high body temperature may benefit reperfusion therapies. We assessed the association of temperature with effective reperfusion (defined as a reduction of ≥8 points in the National Institute of Health Stroke Scale (NIHSS) within the first 24 h) and poor outcome (modified Rankin Scale (mRS) > 2) in 875 retrospectively-included IS patients. We also studied the influence of temperature on thrombolytic (cellular fibronectin (cFn); matrix metalloproteinase 9 (MMP-9)) and inflammatory biomarkers (tumour necrosis factor-alpha (TNF-α), interleukin 6 (IL-6)) and their relationship with effective reperfusion. Our results showed that a higher temperature at 24 but not 6 h after stroke was associated with failed reperfusion (OR: 0.373, p = 0.001), poor outcome (OR: 2.190, p = 0.005) and higher IL-6 levels (OR: 0.958, p < 0.0001). Temperature at 6 h was associated with higher MMP-9 levels (R = 0.697; p < 0.0001) and effective reperfusion, although this last association disappeared after adjusting for confounding factors (OR: 1.178, p = 0.166). Our results suggest that body temperature > 37.5 °C at 24 h, but not at 6 h after stroke, is correlated with reperfusion failure, poor clinical outcome, and infarct size. Mild hyperthermia (36.5–37.5 °C) in the first 6 h window might benefit drug reperfusion therapies by promoting clot lysis.
Highlights
Temperature is a long-known pivotal factor in the development and progression of neurological injuries, in the field of stroke, where approximately 50% of patients develop hyperthermia within the first 24 h [1,2]
This effect was reflected by increased infarct volumes and poor outcome at 3 months in patients treated with recombinant tissue plasminogen activator (rtPA)
Contrary to the observations at 24 h, our analysis showed that temperature at 6 h in rtPA patients was not associated with poor outcome or infarct volume
Summary
Temperature is a long-known pivotal factor in the development and progression of neurological injuries, in the field of stroke, where approximately 50% of patients develop hyperthermia (or fever) within the first 24 h [1,2]. Reperfusion drug therapy with recombinant tissue plasminogen activator (rtPA) remains the treatment of choice during the acute phase of an ischaemic event, its use is limited due to the risk of haemorrhage [13,14,15]. In this regard, body temperature has a relevant influence on the efficacy of thrombolytic therapy. It is not clear if the improvement in clot lysis and efficacy of reperfusion can overcome the deleterious effect of hyperthermia on stroke outcome in rtPA-treated patients
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