Fever is a common condition in intensive care unit (ICU) patients, with an incidence between 30 and 50% in non-neurological ICU patients and up to 70–90% in neurological ICU patients. We aim to perform systematic review and meta-analysis of current literature to assess impact of fever on neurological outcomes and mortality of acute brain injury patients. We searched PubMed/Medline, Scopus and Embase databases following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and we included both retrospective and prospective observational studies, interventional studies, and randomized clinical trials that had data on body temperature and fever during ICU admission. The primary endpoints were neurological outcome and mortality at any time. Secondary outcomes included: early neurological deterioration, delayed cerebral ischemia (DCI, only for patients with subarachnoid hemorrhage), large infarct or hemorrhage size, hemorrhagic transformation (only for patients with ischemic stroke). This study was registered in PROSPERO (CRD42020155903). 180 studies from 14692 records identified after the initial search were included in the final analysis, for a total of 460,825 patients. Fever was associated with an increased probability of unfavorable neurological outcome (pooled OR 2.37 [95% CI 2.08–2.71], I2:92%), death (pooled OR 1.31 [95% CI 1.28–1.34], I2:93%), neurological deterioration (pooled OR 1.10 [95% CI 1.05–1.15]), risk of DCI (pooled OR 1.96 [95% CI 1.73–2.22]), large infarct size (pooled OR 2.94 [95% CI 2.90–2.98]) and hemorrhagic transformation (pooled OR 1.63 [95% CI 1.34–1.97]) and large hemorrhagic volume (pooled OR 2.38 [95% CI 1.94–2.93]). Fever was associated with poor neurological outcomes and mortality in patients with acute brain injury. Whether normothermia should be targeted in the management of all neuro critically ill patients warrants specific research.

中文翻译：

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发热对非缺氧性急性脑损伤患者结局的影响：系统评价和荟萃分析


发热是重症监护病房 （ICU） 患者的常见病症，非神经性 ICU 患者的发病率在 30% 到 50% 之间，在神经性 ICU 患者中的发病率高达 70-90%。我们旨在对当前文献进行系统评价和荟萃分析，以评估发热对急性脑损伤患者的神经系统结局和死亡率的影响。我们按照系统评价和荟萃分析首选报告项目声明的建议检索了 PubMed/Medline、Scopus 和 Embase 数据库，我们纳入了回顾性和前瞻性观察性研究、干预研究和随机临床试验，这些试验有 ICU 入住期间体温和发热的数据。主要终点是神经系统结局和任何时候的死亡率。次要结局包括：早期神经功能恶化、迟发性脑缺血 （DCI，仅适用于蛛网膜下腔出血患者）、大面积梗死或出血面积、出血转化 （仅适用于缺血性卒中患者）。这项研究在 PROSPERO （CRD42020155903） 上注册。初始检索后确定的 14692 条记录中的 180 项研究被纳入最终分析，共涉及 460,825 名患者。发热与不良神经系统结局的可能性增加（合并 OR 2.37 [95% CI 2.08-2.71]，I2：92%）、死亡（合并 OR 1.31 [95% CI 1.28-1.34]，I2：93%）、神经功能恶化（合并 OR 1.10 [95% CI 1.05-1.15]）、DCI 风险（合并 OR 1.96 [95% CI 1.73-2.22]）、大梗死面积（合并 OR 2.94 [95% CI 2.90-2.98]）和出血性转化（合并 OR 1.63 [95% CI 1.34-1.97]）和大出血量（合并 OR2.38 [95% CI 1.94–2.93]）。 发热与急性脑损伤患者的不良神经系统结局和死亡率相关。是否应将正常体温症作为所有神经危重症患者的管理目标，需要进行具体研究。