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Du W, Yang J, Lou Y, You J. Hypothermia on the first day of ICU admission leads to increased in-hospital mortality in patients with subarachnoid hemorrhage. Sci Rep 2024; 14:9730. [PMID: 38678080 PMCID: PMC11055887 DOI: 10.1038/s41598-024-60657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/25/2024] [Indexed: 04/29/2024] Open
Abstract
The relationship between early spontaneous hypothermia and adverse clinical outcomes in patients with subarachnoid hemorrhage (SAH) has not been paid much attention. We designed this retrospective cohort study to determine this relationship by analyzing the association between the lowest body temperature (T-lowest) on the first day of ICU admission and in-hospital mortality. In this study, 550 participants with non-traumatic SAH were chosen from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Multivariate Cox regression analysis showed that T-lowest was nonlinearity correlated with in-hospital mortality (HR = 0.72, 95% CI: 0.59-0.86, p < 0.001). We divided the T-lowest into quartile groups. In comparison to reference group Q1 (31.30-36.06 ℃), group Q3 (36.56-36.72 ℃) had a 50% lower risk of death in the hospital (HR: 0.5, 95% CI: 0.28-0.87, p = 0.014). We further confirmed the curve-like relationship between T-lowest and in-hospital mortality using restricted cubic splines. The mortality is lowest when the T-lowest is close to 36.5 °C, and the risk of death is increased when the temperature is lower or higher than that. Our study demonstrates that in-hospital mortality is associated with T-lowest. Patients with non-traumatic SAH are at increased risk of death if their body temperature on the first day of ICU admission is too low.
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Affiliation(s)
- Wenyuan Du
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China.
| | - Jingmian Yang
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
| | - Yanfang Lou
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
| | - Jiahua You
- Department of Neurology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, China
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Svedung Wettervik T, Hånell A, Ronne-Engström E, Lewén A, Enblad P. Temperature Changes in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Relation to Injury Pattern, Intracranial Pressure Dynamics, Cerebral Energy Metabolism, and Clinical Outcome. Neurocrit Care 2023; 39:145-154. [PMID: 36922474 PMCID: PMC10499919 DOI: 10.1007/s12028-023-01699-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND The aim was to study the course of body temperature in the acute phase of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) in relation to the primary brain injury, cerebral physiology, and clinical outcome. METHODS In this observational study, 166 patients with aSAH treated at the neurosurgery department at Uppsala University Hospital in Sweden between 2008 and2018 with temperature, intracranial pressure (ICP), and microdialysis (MD) monitoring were included. The first 10 days were divided into the early phase (days 1-3) and the vasospasm phase (days 4-10). RESULTS Normothermia (temperature = 36-38 °C) was most prevalent in the early phase. A lower mean temperature at this stage was univariately associated with a worse primary brain injury, with higher Fisher grade and higher MD glycerol concentration, as well as a worse neurological recovery at 1 year. There was otherwise no association between temperature and cerebral physiological variables in the early phase. There was a transition toward an increased burden of hyperthermia (temperature > 38 °C) in the vasospasm phase. This was associated with concurrent infections but not with neurological or radiological injury severity at admission. Elevated temperature was associated with higher MD pyruvate concentration, lower rate of an MD pattern indicative of ischemia, and higher rate of poor neurological recovery at 1 year. There was otherwise no association between temperature and cerebral physiological variables in the vasospasm phase. The associations between temperature and clinical outcome did not hold true in multiple logistic regression analyses. CONCLUSIONS Spontaneously low temperature in the early phase reflected a worse primary brain injury and indicated a worse outcome prognosis. Hyperthermia was common in the vasospasm phase and was more related to infections than primary injury severity but also with a more favorable energy metabolic pattern with better substrate supply, possibly related to hyperemia.
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Affiliation(s)
- Teodor Svedung Wettervik
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden.
| | - Anders Hånell
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Elisabeth Ronne-Engström
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Anders Lewén
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Per Enblad
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
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Shibukawa S, Konta N, Niwa T, Miyati T, Yonemochi T, Yoshimaru D, Horie T, Kuroda K, Sorimachi T. Temperature measurement of intracranial cerebrospinal fluid using diffusion tensor imaging after revascularization surgery in Moyamoya disease. Magn Reson Imaging 2023; 99:1-6. [PMID: 36608908 DOI: 10.1016/j.mri.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Brain temperature monitoring using a catheter thermometer has been reported to be a useful technique to predict prognosis in neurosurgery. To investigate the possibility of measuring intracranial cerebrospinal fluid temperature for postoperative monitoring in patients with Moyamoya disease (MMD) after bypass surgery. MATERIALS AND METHODS This study evaluated fifteen patients with MMD who were indicated for bypass surgery. Diffusion tensor imaging for brain thermometry were performed on a 1.5-T MR scanner. Intracranial cerebrospinal fluid temperature with/without considering the fractional anisotropy component, body temperature, C-reactive protein levels, white blood cell count, and cerebral blood flow measured by 123I-IMP single-photon emission computed tomography were obtained before surgery and 1-3 days after surgery. Pixel values considered to be signal outliers in fractional anisotropy processing were defined as cerebrospinal fluid noise index and calculated. Wilcoxon signed-rank test and effect size were performed to compare the changes before and after revascularization. Spearman's rho correlation coefficient was used to analyze the correlations between each parameter. Statistical significance was defined as p < 0.05. RESULTS All parameter values became significantly higher compared to those measured before revascularization (p < 0.01 in all cases). The effect sizes were largest for the cerebrospinal fluid temperature with fractional anisotropy processing and for C-reactive protein levels (Rank-biserial correlation = 1.0). The cerebrospinal fluid noise index and cerebrospinal fluid temperatures with fractional anisotropy processing (r = 0.84, p < 0.0001) or without fractional anisotropy processing (r = 0.95, p < 0.0001) showed highly significant positive correlations. Although no significant correlation was observed, cerebrospinal fluid temperatures with fractional anisotropy had small or moderately positive correlations with cerebral blood flow, body temperature, C-reactive protein levels, and white blood cell count (r = 0.37, 0.42, 0.41, and 0.44, respectively; p > 0.05). CONCLUSION Our findings suggest the possibility of postoperative monitoring for MMD patients by measuring intracranial cerebrospinal fluid temperature with fractional anisotropy processing. Intracranial cerebrospinal fluid temperature might be considered as combined response since cerebrospinal fluid, body temperature, and inflammation are equally correlated.
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Affiliation(s)
- Shuhei Shibukawa
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-Ku, Tokyo, Japan; Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Meguro-ku, Tokyo, Japan; Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Natsuo Konta
- Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takuya Yonemochi
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Daisuke Yoshimaru
- Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan; Jikei University School of Medicine, Division of Regenerative Medicine
| | - Tomohiko Horie
- Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Course of Electrical and Electronic Engineering, Graduate School of Engineering, Tokai University
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Zhou Z, Liu Z, Zhang C, Zhang W, Zhang C, Chen T, Wang Y. Mild hypothermia alleviates early brain injury after subarachnoid hemorrhage via suppressing pyroptosis through AMPK/NLRP3 inflammasome pathway in rats. Brain Res Bull 2023; 193:72-83. [PMID: 36535306 DOI: 10.1016/j.brainresbull.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
As a subtype of stroke, subarachnoid hemorrhage (SAH) has a notoriously high rate of disability and mortality owing to the lack of effective intervention. Early brain injury (EBI) is the main factor responsible for the dismal prognosis of SAH patients. The current study intends to explore the molecular mechanism underlying the effect of MH on EBI after SAH from a novel perspective of pyroptosis, a highly specific inflammatory programmed cell death, in the SAH rat model. Sprague-Dawley (SD) rats were divided into different groups in accordance with various treatments. In the treatment group, the rats underwent mild hypothermia for 4 h after modeling; in the inhibitor group, Compound C (an inhibitor of AMPK) was administered intravenous injections (i.v.) 30 min before modeling. Neurological score, neuronal death, brain water content, inflammatory reaction, and expression levels of pyroptosis-related proteins were evaluated in the rats. Our results indicate that the MH therapy significantly increased the neurological score and assuaged brain edema, neuronal injury, and inflammatory reaction induced by SAH. Meanwhile, MH therapy upregulated the level of AMPK phosphorylation whereas downregulated the protein expressions of NLRP3, ASC, cleaved caspase-1, GSDMD, IL-1β, and IL-18. The reversed effect of MH therapy by Compound C concretely indicated that MH therapy inhibited pyroptosis through an AMPK-dependent pathway. Our study also found that MH therapy potently curbed the increasing trend of brain temperature (BT), rectal temperature (RT), and ICP after SAH. Taken together, our data indicate that the neuroprotective effects of MH therapy were manifested by inhibiting pyroptosis via the AMPK/NLRP3 inflammasome pathway, which may serve as a promising therapy for the intervention of SAH.
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Affiliation(s)
- Zhaopeng Zhou
- Department of Neurosurgery, The 904th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, China
| | - Zhuanghua Liu
- Department of Neurosurgery, The 904th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, China
| | - Chenxu Zhang
- Department of Neurosurgery, The 904th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, China
| | - Wang Zhang
- Department of Neurosurgery, The 904th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, China
| | - Chunlei Zhang
- Department of Neurosurgery, The 904th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, China
| | - Tao Chen
- Department of Neurosurgery, The 904th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, China.
| | - Yuhai Wang
- Department of Neurosurgery, The 904th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, China.
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Zhou Z, Liu Z, Yang H, Zhang C, Zhang C, Chen J, Wang Y. A nomogram for predicting the risk of poor prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage following microsurgical clipping. Front Neurol 2023; 14:1146106. [PMID: 37034089 PMCID: PMC10073426 DOI: 10.3389/fneur.2023.1146106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective Aneurysmal subarachnoid hemorrhage (aSAH) is a common and potentially fatal cerebrovascular disease. Poor-grade aSAH (Hunt-Hess grades IV and V) accounts for 20-30% of patients with aSAH, with most patients having a poor prognosis. This study aimed to develop a stable nomogram model for predicting adverse outcomes at 6 months in patients with aSAH, and thus, aid in improving the prognosis. Method The clinical data and imaging findings of 150 patients with poor-grade aSAH treated with microsurgical clipping of intracranial aneurysms on admission from December 2015 to October 2021 were retrospectively analyzed. Least absolute shrinkage and selection operator (LASSO), logistic regression analyses, and a nomogram were used to develop the prognostic models. Receiver operating characteristic (ROC) curves and Hosmer-Lemeshow tests were used to assess discrimination and calibration. The bootstrap method (1,000 repetitions) was used for internal validation. Decision curve analysis (DCA) was performed to evaluate the clinical validity of the nomogram model. Result LASSO regression analysis showed that age, Hunt-Hess grade, Glasgow Coma Scale (GCS), aneurysm size, and refractory hyperpyrexia were potential predictors for poor-grade aSAH. Logistic regression analyses revealed that age (OR: 1.107, 95% CI: 1.056-1.116, P < 0.001), Hunt-Hess grade (OR: 8.832, 95% CI: 2.312-33.736, P = 0.001), aneurysm size (OR: 6.871, 95% CI: 1.907-24.754, P = 0.003) and refractory fever (OR: 3.610, 95% CI: 1.301-10.018, P < 0.001) were independent predictors of poor outcome. The area under the ROC curve (AUC) was 0.909. The calibration curve and Hosmer-Lemeshow tests showed that the nomogram had good calibration ability. Furthermore, the DCA curve showed better clinical utilization of the nomogram. Conclusion This study provides a reliable and valuable nomogram that can accurately predict the risk of poor prognosis in patients with poor-grade aSAH after microsurgical clipping. This tool is easy to use and can help physicians make appropriate clinical decisions to significantly improve patient prognosis.
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Study of Brain Circadian Rhythms in Patients with Chronic Disorders of Consciousness and Healthy Individuals Using Microwave Radiometry. Diagnostics (Basel) 2022; 12:diagnostics12081777. [PMID: 35892486 PMCID: PMC9331034 DOI: 10.3390/diagnostics12081777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
The study of circadian rhythms in the human body using temperature measurements is the most informative way to assess the viability of the body’s rhythm-organizing systems. Pathological processes can affect circadian rhythm dynamics in damaged organs. Severe brain damage that caused the development of disorders of consciousness (DOC) (strokes, traumatic brain injury) disrupts the activity of central oscillators, by directly damaging or destroying the periphery links, and the level of preservation of circadian rhythms and the dynamics of their recovery can be informative diagnostic criteria for patient’s condition assessment. This study examined 23 patients with DOC by using a non-invasive method for obtaining body and cerebral cortex temperature to compare with healthy controls. Measurements were made with a 4 h interval for 52 h beginning at 08:00 on day 1 and ending at 08:00 on day 3. The profile of patients with DOC showed complete disruption compared to healthy controls with rhythmic patterns. The results indicate that the mechanisms for maintaining brain circadian rhythms are different from general homeostasis regulation of the body. Use of microwave radio thermometry for the identification of rehabilitation potential in patients with DOC is a promising area of investigation.
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Kuo LT, Lu HY, Huang APH. Prognostic Value of Circadian Rhythm of Brain Temperature in Traumatic Brain Injury. J Pers Med 2021; 11:jpm11070620. [PMID: 34208924 PMCID: PMC8307466 DOI: 10.3390/jpm11070620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Hypothermia has been used in postoperative management of traumatic brain injury (TBI); however, the rhythmic variation and prognostic value of brain temperature after TBI have never been studied. This study describes diurnal brain temperature patterns in comatose patients with TBI. Mesors of brain temperature, amplitude, and acrophase were estimated from recorded temperature measurements using cosinor analysis. The association of these patterns with clinical parameters, mortality, and functional outcomes in a 12-month follow-up was examined. According to the cosinor analysis, 59.3% of patients presented with circadian rhythms of brain temperature in the first 72 h postoperatively. The rhythm-adjusted mesor of brain temperature was 37.39 ± 1.21 °C, with a diminished mean amplitude of 0.28 (±0.25) °C; a shift of temperature acrophase was also observed. Multivariate logistic regression analysis revealed that initial Glasgow coma scale score, age, elevated blood glucose level, and circadian rhythm of brain temperature seemed to be predictive and prognostic factors of patients' functional outcomes. For the prediction of survival status, younger patients or those patients with mesor within the middle 50% of brain temperature were more likely to survive. The analysis of brain temperature rhythms in patients with moderate and severe TBI provided additional predictive information related to mortality and functional outcomes.
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Affiliation(s)
- Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung San South Road, Taipei 100, Taiwan;
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin 64002, Taiwan;
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung San South Road, Taipei 100, Taiwan;
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
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