1. TEMPERATURE CHANGE, SHORT- AND LONG-TERM HANDICAP IN ACUTE ISCHEMIC STROKE Kakaletsis Nikolaos 1, Papavasileiou Vasileios 1, Lambrou Dimitrios 2, Ntaios George 2, Michel Patrik 2 LARISSA 21 March 2015 1.Department of Clinical Neurosciences and Preventive Medicine, Danube University in Krems, Austria 2. Stroke Center, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. Centre Cérébrovasculaire 2

2. Introduction ESO-Guidelines for Management of Ischaemic Stroke 2008 It is recommended that the presence of pyrexia (temperature >37.5°C) should prompt a search for concurrent infection (Class IV, GCP) Treatment of pyrexia (temperature >37.5°C) with paracetamol and fanning is recommended (Class III, Level C) ~ 1/3 of patients admitted with stroke will be hyperthermic (temperature >37,5 °C) within the first hours after stroke onset. Hyperthermia is associated with poor neurological outcome, possibly secondary to increased metabolic demands, enhanced release of neurotransmitters, and increased free radical production. A raised body temperature should prompt a search for infection and treatment where appropriate (infective endocarditis, pneumonia, urinary tract infection, sepsis). Studies with antipyretic medication have been inconclusive, but treatment of raised body temperature (>37.5°C ) with paracetamol is common practice in stroke patients. 3 Azzimondi G, Fever in acute stroke worsens prognosis: a prospective study. Stroke. 1995;26:2040–2043 Reith J, Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 1996;347:422-42 Hajat C, Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke 2000;31:410-414

3. Aim - Methods The aim of the study is to explore the association between baseline temperature (T) levels & T change during the first 24 hours, and functional outcome in a representative acute ischemic stroke (AIS) population. ASTRAL is the prospective registry of all consecutive patients admitted to the stroke unit or intensive care unit of the Central University Hospital of Vaud (CHUV) with acute ischemic stroke within 24 hours after last proof of well-being. All patients registered in the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) between 1/1/2003 and 31/12/2013 were analyzed (n=2,555). Unfavorable outcomes at 7 days, 3 and 6 months were defined as modified Rankin scores>2. A local polynomial surface algorithm was used to assess the effect of T values on the three outcomes. (Kernel smoothing surface methodology) 4

4. Association of Probability of Unfavorable Outcome (mRS>2) with Temperature Acute T Subacute T 5

5. Association of Temperature with Probability of mRS>2 7 days 3 months 12 months 6 Conclusions Elevated body temperature in AIS is associated with a worse functional outcome, but initial hypothermia does not seem to be protective. These insights may help to adapt individual treatment decisions and to plan future therapeutic studies.