Prognostic Significance of Early Fever in Convulsive Status Epilepticus: Insights from the ICTAL Registry.

BACKGROUND

Fever is one of the secondary brain insults that may alter outcome after acute brain injury. However, its deleterious role in convulsive status epilepticus (CSE) remains insufficiently established in humans. We aimed to determine whether early fever is associated with functional neurological outcome in patients with CSE.

METHODS

We conducted a prospective multicenter study using data from the ICTAL Registry, including adult patients with CSE admitted to 23 French intensive care units (ICUs). Fever, defined as a core temperature ≥ 38 °C, was assessed during the first 24 h following CSE onset. Multivariable logistic regression analyses were used to evaluate the independent association between early fever and 90-day favorable neurological outcome, defined as a Glasgow Outcome Scale (GOS) score of 4-5.

RESULTS

Among 952 included patients, 382 (41.2%) developed fever within the first 24 h of ICU stay. The underlying causes of fever appeared to be multifactorial, including infectious etiologies related to CSE itself (either systemic or central nervous system infections), early aspiration pneumonia, and the intensity of convulsive activity. After matching, only the intensity of convulsive activity remained associated with the occurrence of fever. In multivariable analyses, independent predictors of favorable outcome were age < 60 years and a Charlson Comorbidity Index < 3, whereas cerebral insult as CSE etiology and refractory CSE were associated with unfavorable outcome. Early fever was not independently associated with 90-day functional outcome.

CONCLUSIONS

Early fever is highly prevalent in convulsive status epilepticus and appears to reflect seizure intensity rather than overall disease severity. It was not independently associated with 90-day neurological outcome, suggesting no major prognostic impact, although a modest association cannot be excluded. These findings should therefore be interpreted with caution and do not allow conclusions regarding the impact of temperature-control strategies.