LAUSR

OBJECTIVE Fever in aneurysmal subarachnoid hemorrhage (aSAH) has been associated with delayed cerebral ischemia (DCI), but its relevance in risk stratification has not been explored. This study investigates if early temperature elevation following aSAH predicts impending clinical deterioration caused by DCI. METHODS Relevant cases were identified from a prospectively maintained database for consecutive aSAH patients treated at our center between July 2015 and January 2020. Two hourly temperature readings for individual patients from admission through to day 14 were recorded and analyzed. Demographic, clinical, treatment and angiographic data were extracted from the electronic medical record. The primary end point was the occurrence of DCI (clinical and radiographic vasospasm). Multivariate logistic regression analyses were performed to account for patient age, smoking status, and VASOGRADE. RESULTS On hundred and seventy-five patients (124 female) with aSAH were treated. The median age at diagnosis was 55.4 years (range 20.5 to 87.2 years). Clinical DCI occurred in 58 patients, of which 2 (1.1%) responded to hemodynamic augmentation and 56 (32.0%) required intraarterial therapy. Temperature graphs showed a marked divergence on day 4 between clinical DCI and non-DCI groups (1.12 °C ± 0.15 and 0.76°C ± 0.08 respectively, p=0.007). Patients with temperature elevation ≥2.5°C on day 4 or 5 compared to their admission temperature were more likely to clinically deteriorate due to DCI (OR 4.55 95% CI 1.31 - 15.77, p=0.017). CONCLUSION Temperature elevation of 2.5°C or more on day 4 or 5 compared to baseline suggests a greater risk of clinical deterioration due to DCI.