A higher body temperature is associated with haemorrhagic transformation in patients with acute stroke untreated with recombinant tissue-type plasminogen activator (rtPA)

Rogelio Leira, Tomás Sobrino, Miguel Blanco, Francisco Campos, Manuel Rodríguez-Ýñez, Mar Castellanos, Octavio Moldes, Mónica Millán, Antoni Dávalos, JośE Castillo

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Abstract

Higher body temperature is a prognostic factor of poor outcome in acute stroke. Our aim was to study the relationship between body temperature, HT (haemorrhagic transformation) and biomarkers of BBB (blood-brain barrier) damage in patients with acute ischaemic stroke untreated with rtPA (recombinant tissue-type plasminogen activator). We studied 229 patients with ischaemic stroke<12h fromsymptom onset. Body temperature was determined at admission and every 6h during the first 3 days. HT was evaluated according to ECASS II (second European Co-operative Acute Stroke Study) criteria in a multimodal MRI (magnetic resonance imaging) at 72h. We found that 55 patients (34.1%) showed HT. HT was associated with cardioembolic stroke (64.2% against 23.0%; P<0.0001), higher body temperature during the first 24h (36.9 °C compared with 36.5 °C; P<0.0001), more severe stroke [NIHSS (National Institutes of Health Stroke Scale) score, 14 (9-20) against 10 (7-15); P=0.002], and greater DWI (diffusion-weighted imaging) lesion volume at admission (23.2cc compared with 13.2cc; P<0.0001). Plasma MMP-9 (matrix metalloproteinase 9) (187.3ng/ml compared with 44.2ng/ml; P<0.0001) and cFn (cellular fibronectin) levels (16.3μg/ml compared with 7.1μg/ml; P=0.001) were higher in patients with HT. Body temperature within the first 24h was independently associated with HT {OR (odds ratio), 7.3 [95% CI (confidence interval), 2.4-22.6]; P<0.0001} after adjustment for cardioembolic stroke subtype, baseline NIHSS score and DWI lesion volume. This effect remained unchanged after controlling for MMP-9 and cFn. In conclusion, high body temperature within the first 24h after ischaemic stroke is a risk factor for HT in patients untreated with rtPA. This effect is independent of some biological signatures of BBB damage. © The Authors Journal compilation © 2012 Biochemical Society.
Original languageEnglish
Pages (from-to)113-119
JournalClinical Science
Volume122
Issue number3
DOIs
Publication statusPublished - 1 Feb 2012

Keywords

  • Biomarkers
  • Blood-brain barrier (BBB)
  • Haemorrhagic transformation (HT)
  • Ischaemic stroke
  • Temperature

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    Leira, R., Sobrino, T., Blanco, M., Campos, F., Rodríguez-Ýñez, M., Castellanos, M., Moldes, O., Millán, M., Dávalos, A., & Castillo, J. (2012). A higher body temperature is associated with haemorrhagic transformation in patients with acute stroke untreated with recombinant tissue-type plasminogen activator (rtPA). Clinical Science, 122(3), 113-119. https://doi.org/10.1042/CS20110143