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dc.contributor.authorSharma, Jagdish C.
dc.contributor.authorRoss, Ian N.
dc.date.accessioned2017-08-24T15:17:10Z
dc.date.available2017-08-24T15:17:10Z
dc.date.issued1998
dc.identifier.citationSharma, J. C. & Ross, I. N. (1998). Antipyretic therapy in acute stroke. The Lancet, 352 (9129), pp.740-741.
dc.identifier.other10.1016/s0140-6736(05)60861-6
dc.identifier.urihttp://hdl.handle.net/20.500.12904/11756
dc.description.abstractSir Jacques De Keyser1 advocates that stroke patients with raised body temperature (?37�5�C) should be treated with that antipyretics. His recommendation is based on studies which showed that pyrexia is an independent predictor of mortality and morbidity. In none of the studies he quotes, however, has dysphagia been analysed with pyrexia. We prospectively studied 294 patients admitted with acute stroke. Predictors of mortality within 90 days were analysed by Cox's regression analysis. The most significant predictors of mortality were dysphagia (relative risk 4�10 [95% CI 2�39�7�05], p<0�001), pre-existing cardiovascular disease (2�19 [1�45�3�30], p<0�001), a Glasgow coma score of less than 11 (2�22 [1�48�3�33], p<0�001), and a Rankin score of more than 1 (1�78 [1�20�2�64], p=0�004). Pyrexia was not a significant variable (0�91 [0�60�1�40], p=0�498). Dysphagia was the most important indicator of stroke mortality. Pyrexia may be related to stroke severity in some patients, but is more likely to be related to aspiration in the 54% of patients who have unsafe swallowing.2 Furthermore, R MacWalter and coworkers3 found in a large prospective study that body temperature on admission did not predict long-term outcome after an acute stroke. In view of these findings, we believe that De Keyser is wrong to recommend antipyretic use in stroke without the evidence from a controlled trial.
dc.description.urihttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)60861-6/fulltext
dc.subjectStroke
dc.subjectPhysiological effects of drugs
dc.titleAntipyretic therapy in acute stroke
dc.typeCorrespondence
html.description.abstractSir Jacques De Keyser1 advocates that stroke patients with raised body temperature (?37�5�C) should be treated with that antipyretics. His recommendation is based on studies which showed that pyrexia is an independent predictor of mortality and morbidity. In none of the studies he quotes, however, has dysphagia been analysed with pyrexia. We prospectively studied 294 patients admitted with acute stroke. Predictors of mortality within 90 days were analysed by Cox's regression analysis. The most significant predictors of mortality were dysphagia (relative risk 4�10 [95% CI 2�39�7�05], p<0�001), pre-existing cardiovascular disease (2�19 [1�45�3�30], p<0�001), a Glasgow coma score of less than 11 (2�22 [1�48�3�33], p<0�001), and a Rankin score of more than 1 (1�78 [1�20�2�64], p=0�004). Pyrexia was not a significant variable (0�91 [0�60�1�40], p=0�498). Dysphagia was the most important indicator of stroke mortality. Pyrexia may be related to stroke severity in some patients, but is more likely to be related to aspiration in the 54% of patients who have unsafe swallowing.2 Furthermore, R MacWalter and coworkers3 found in a large prospective study that body temperature on admission did not predict long-term outcome after an acute stroke. In view of these findings, we believe that De Keyser is wrong to recommend antipyretic use in stroke without the evidence from a controlled trial.


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