1. Timing Of Fever And Risk Of Vasospasm Post Aneurysmal Subarachnoid Hemorrhage (aSAH) Faheem Sheriff, MD, Joshua Raines, BS, Charles Murchison, MS, Justin Cetas, MD, Holly E. Hinson, MD Department of Neurology, Oregon Health & Science University, Portland, Oregon. AB 1.Early fever is associated with a markedly increased odds of developing vasospasm and clinical worsening attributable to vasospasm. 2.Younger age is associated with increased odds of vasospasm and clinical worsening attributable to vasospasm 3.Early febrile patients may warrant closer monitoring and earlier treatment in the prevention of clinical worsening attributable to vasospasm, which in turn may be associated with improved outcomes. Table 2. Covariates associated with vasospasm Conclusions Discussion Introduction Results Continued Figure 1. ROC of risk factors & odds vasospasmFigure 2. ROC of risk factors & clinical worsening We conducted a retrospective review of 72 consecutive patients admitted to the Neurological Sciences Intensive Care Unit (NSICU) from January 2011- December 2012 with a diagnosis of aSAH. Early Fever was defined as any temperature above 38.0°C in the first 48 hours. Vasospasm was defined as large vessel narrowing as seen on angiogram. Clinical worsening was defined as neurological decline attributable to vasospasm. Statistical analysis consisted of logistic regression with vasospasm detection and clinical deterioration due to vasospasm as the dependent outcomes. Demographic variables are summarized in table 1. Potential predictors of vasospasm and clinical deterioration are listed in table 2. Overall capacity of model classification was assessed using Receiver-Operator Characteristic curves (ROC). Early fever was the strongest predictor of vasospasm and vasospasm attributable clinical worsening. In accordance with previous known risk factors, younger age was associated with vasospasm. (3,4) On multivariate analysis, H&H, Fisher grade and sex were not associated with vasospasm development nor vasospasm attributable clinical worsening. This is likely due to a lack of power. Taken together, these risk factors may help raise the clinical suspicion of potential vasospasm and clinical neurological worsening attributable to vasospasm, as supported by the receiver operating characteristic curves in figures1 and 2. Detected VasospasmClinical Worsening Assessed Vasospasm Covariates (N=72) Descriptive Statistics [mean +/- s.d. or N (%)] Odds Ratios [CI] p-value Odds Ratios [CI] p-value Age (years)55.2 +/- 14.1 -1.06 / year [-1.013, -1.11] p=0.012 -1.06 / year [-1.01, -1.12] p=0.031 Sex (% female)50 (69%) 1.36 [0.39, 4.67] p=0.63 1.42 [0.32, 6.30] p=0.65 Hunt Hess Score Median [IQR] 2 [2-4] 1.61 [0.78, 3.33] p=0.19 -1.15 [-0.55, -2.39] p=0.71 Fisher Grade Median [IQR] 4 [3-4] -1.40 [-0.66, -2.97] p=0.39 1.91 [0.59, 6.12] p=0.28 Presenting Early Fever (%) 17 (23.6%) 223 [6.04, 8240] p=0.0033 307 [5.55, 1690] p=0.0051 Afebrile (N=55) [mean (s.d.) or N (%)] Early Febrile (N=17) Entire Cohort (N=72) Age (years)55 +/- 14.656 +/- 12.755.2 +/- 14.1 Sex (% female)38 (69%)12 (71%)50 (69%) Race (% Caucasian)44 (80%)16 (94%)60 (83%) Hunt & Hess Score Median [IQR] 2 [1.5-3]3 [2-4]2 [2-4] Fischer Grade Median [IQR] 3 [3-4]4 [3-4] Hospital LOS (days)15.1 +/- 7.4019.2 +/- 8.5816.1 +/- 7.83 Detected Vasospasm (%) 21 (38%)12 (71%)33 (46%) Clinical Deterioration (%) 10 (18%)8 (47%)18 (25%) Table 1. Demographics The project described was supported by Award Number 5K12HL108974-05 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. Methods Results Fever is independently associated with both vasospasm and worse outcomes after aSAH, but it is not clear if the timing of fever is associated with the development of vasospasm. (1,2) Early predictors of vasospasm may provide important clues in detecting SAH patients who may need more intensive therapy to prevent poor outcomes. 1.Naideck, AM, BR Bendok, RA Bernstein, MJ Alberts, CM Watts, and TP Bleck. "Fever Burden and Functional Recovery after Subarachnoid Hemorrhage." Journal of Neurosurgery 63.2 (2008): 212-7. Print. 2.Oliveira-Filho, J., MA Ezzeddine, AZ Segal, FS Buonanno, Y. Chang, CS Ogilvy, G. Rordorf, LH Schwamm, WJ Koroshetz, and CT Mcdonald. "Fever in Subarachnoid Hemorrhage: Relationship to Vasospasm and Outcome." Journal of Neurology 56.10 (2011): 1299-304. Print. 3.Dupont, SA, EF Wijdicks, EM Manno, G. Lanzino, and AA Rabinstein. "Prediction of Angiographic Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Value of the Hijdra Sum Scoring System." Neurocritical Care 11.2 (2009): 172-76. Print. 4.Edgell, RC, A. Alshekhlee, A. Borhani Haghighi, J. Sweeny, J. Kitchener, N. Vora, BK Bieneman, S. Cruz-Flores, and S. Abdulrauf. "Age-associated Vasospasm in Aneurysmal Subarachnoid Hemorrhage." Ed. SP Kale. Journal of Stroke & Cerebrovascular Disease 1 (201): 22-27. Print Disclosures References