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Early temperature and mortality in critically ill patients with acute neurological presentations: trauma and stroke differ from infection.

Figure 1. Flow chart for patients included in the analysis (ANZ and UK Data)

ANZ data

UK Data


Table 1: Diagnostic codes for neurological injury used for ANZICS APD and ICNARC Coding Methods.

ANZICS APD APACHE III Diagnostic Codes / ICNARC Coding Method
TBI / 1601 + 601
409
1502 / 1.1.10.7.7
1.1.10.38.1 to 1.1.10.38.8
1.4.2.7.7
1.4.2.38.1 to 1.4.2.38.8
1.5.4.2.1 to 1.5.4.2.8
2.1.10.7.7
2.1.10.38.1 to 2.1.10.38.8
2.4.2.7.7
2.4.2.38.1 to 2.4.2.38.8
2.5.4.2.1 to 2.5.4.2.8
Acute Ischaemic stroke / 403 / 1.1.10.41.3
1.4.2.41.3
2.1.10.41.3
2.4.2.41.3
Subarachnoid Haemorrhage / 402
1503 / 1.1.10.15.2
1.1.10.41.1 to 1.1.10.41.2
1.4.2.15.2
1.4.2.41.1 to 1.4.2.41.2
2.1.10.15.2
2.1.10.41.1 to 2.1.10.41.2
2.4.2.15.2
2.4.2.41.1 to 2.4.2.41.2
Intracerebral Haemorrhage / 1501
401 / 1.1.10.15.1
1.1.10.15.3 to 1.1.10.15.4
1.4.2.15.1
1.4.2.15.3 to 1.4.2.15.4
2.1.10.15.1
2.1.10.15.3 to 2.1.10.15.4
2.4.2.15.1
2.4.2.15.3 to 2.4.2.15.4
Central Nervous System infection / 404 / 1.1.10.27.1 to 1.1.10.27.7
1.4.2.27.1 to 1.4.2.27.3
1.4.2.27.5 to 1.4.2.27.8
2.1.10.27.1 to 2.1.10.27.7
2.4.2.27.1 to 2.4.2.27.3
2.4.2.27.5 to 2.4.2.27.8
ANZ / UK
Patients included in cohort
(n=24,002) / Patients with missing data
(n=8,246) / Patients included in cohort (n=51,434) / Patients with missing data (n=2,347)
Age/years / 52.4 (20.5) / 50.92 (20.46) / 52.4 (18.4) / 53.2 (18.5)
Gender/Male % (n) / 64% / 63% / 60% (30743) / 60% (1405)
APACHE II Score / 16.7 (7.8) / 16.8 (7.8) / 15.3 (7.3) / 11.9 (6.7)
APACHE III Score / 52.6 (28.8) / 51.9 (28.5) / N/A / N/A
ICNARC Physiology Score / N/A / N/A / 16.4 (8.0) / 12.3 (8.0)
APACHE II Risk of Deatha / 0.20 (0.08-039) / 0.2 (0.09-0.41) / 0.29 (0.13-0.54) / 0.27 (0.13-0.46)
APACHE III Risk of Death / 0.14 (0.04-0.41) / 0.14 (0.04-0.4) / N/A / N/A
ICNARC Risk of Death / N/A / N/A / 0.24 (0.10-0.51) / 0.17 (0.07-0.40)
Peak Temp/°C / 37.5 (0.8) / 37.4 (1.2) / 37.5 (0.9) / 37.5 (0.9)
GCS (cif not sedated for entire 1st 24 hours) / Verbal / 3 (1-5) / 2 (1-5) / 2 (1-5) / 1 (1-4)
Motor / 5 (2-6) / 5 (1-6) / 5 (2-6) / 5 (1-6)
Eye / 3 (1-4) / 2 (1-4) / 3 (1-4) / 2 (1-3)
Total / 9.7 (4.7) / 9.1 (4.7) / 9.3 (4.6) / 8.4 (4.3)
Intubated % (n) / 63% / 65% / 70% (32280) / 76% (1330)
Acute Hospital Mortality % (n) / 23% / 24% / 33% (16902) / 45% (753)
Acute Hospital Length of Stay Median Days (IQR) / 11.8 (5, 24.9) / 9.7 (2.6, 23.9) / 14 (5-38) / 9 (2-25)

Table 2: Comparison of ANZ included patients with patients that were excluded because of missing data.

Table 3: Acute hospital mortality for subgroups of TBI/Stroke according to peak temperature (0.5°C bands).

Values are deaths/N (%)

ANZ / UK
Peak Temp (°C) / TBI / Ischaemic stroke / Subarachnoid/ intracranial haemorrhage / TBI / Ischaemic stroke / Subarachnoid/ intracranial haemorrhage
<36.0 / 191/618 (30.9) / 54/106 (50.9) / 260/415 (62.7) / 279/463 (60.3) / 53/83 (63.9) / 599/720 (83.2)
36.0-36.4 / 162/1047 (15.5) / 106/376 (28.2) / 304/792 (38.4) / 285/820 (34.8) / 125/276 (45.3) / 902/1645 (54.8)
36.5-36.9 / 311/2925 (10.6) / 223/1027 (21.7) / 583/2321 (25.1) / 525/2075 (25.3) / 280/758 (36.9) / 1609/4411 (36.5)
37.0-37.4 / 491/4825 (10.2) / 429/1431 (30.0) / 951/4151 (22.9) / 718/3786 (19.0) / 382/1048 (36.5) / 2144/6663 (32.2)
37.5-37.9 / 486/4599 (10.6) / 409/1112 (36.8) / 902/3363 (26.8) / 715/3932 (18.2) / 388/959 (40.5) / 1981/5358 (37.0)
38.0-38.4 / 416/3287 (12.7) / 306/631 (48.5) / 617/1928 (32.0) / 602/3006 (20.0) / 281/557 (50.4) / 1380/3257 (42.4)
38.5-38.9 / 222/1466 (15.1) / 171/291 (58.8) / 305/720 (42.4) / 321/1398 (23.0) / 156/299 (52.2) / 748/1465 (51.1)
39.0-39.4 / 112/416 (26.9) / 75/124 (60.5) / 152/266 (57.1) / 186/501 (37.1) / 75/130 (57.7) / 408/656 (62.2)
39.5-39.9 / 36/110 (32.7) / 30/42 (71.4) / 76/110 (69.1) / 91/187 (48.7) / 28/43 (65.1) / 185/244 (75.8)
40.0+ / 43/66 (65.2) / 25/36 (69.4) / 63/78 (80.8) / 84/103 (81.6) / 34/37 (91.9) / 144/158 (91.1)

Table 4: ANZ Data: Unadjusted odds ratio for acute hospital mortality for the TBI/Stroke subgroups according to peak temperature (0.5°C bands)

Values are OR (95% CI)

Peak Temp (°C) / TBI / AIS / SAH/ICH
<36.0 / 3.95 (3.25,4.80) / 2.43 (1.63, 3.61) / 5.64 (4.57, 6.97)
36.0-36.4 / 1.62 (1.33,1.96) / 0.92 (0.71, 1.18) / 2.10 (1.79, 2.46)
36.5-36.9 / 1.05 (0.90, 1.22) / 0.65 (0.54, 0.78) / 1.13 (1.00, 1.27)
37.0-37.4 / 1.00 / 1.00 / 1.00
37.5-37.9 / 1.04 (0.91,1.19) / 1.36 (1.15, 1.60) / 1.23 (1.11, 1.37)
38.0-38.4 / 1.28 (1.11, 1.47) / 2.20 (1.81, 2.67) / 1.58 (1.40, 1.79)
38.5-38.9 / 1.58 (1.33, 1.87) / 3.33 (2.57, 4.31) / 2.47 (2.10, 2.92)
39.0-39.4 / 3.25 (2.57, 4.12) / 3.57 (2.45, 5.21) / 4.49 (3.48, 5.78)
39.5-39.9 / 4.29 (2.85, 6.46) / 5.84 (2.96, 11.51) / 7.52, 4.99, 11.34)
40.0+ / 16.5 (9.86, 27.61) / 5.31 (2.59, 10.88) / 14.13 (8.01, 24.93)

Test of interaction: P < 0.0001

Table 5: ANZ Data: Adjusted odds ratio for acute hospital mortality for the TBI/Stroke subgroups according to peak temperature (0.5°C bands)

Values are OR (95% CI)

Adjusted for predicted log odds of acute hospital mortality from APACHE III model (excluding weightings for temperature and sedation/GCS).

Peak Temp (°C) / TBI / AIS / SAH/ICH
<36.0 / 2.56 (1.98, 3.32) / 2.52 (1.54, 4.10) / 2.20 (1.66, 2.90)
36.0-36.4 / 1.72 (1.34, 2.20) / 1.21 (0.88, 1.65) / 1.77 (1.41, 2.21)
36.5-36.9 / 1.14 (0.95, 1.38) / 0.88 (0.71, 1.11) / 1.27 (1.08, 1.48)
37.0-37.4 / 1.00 / 1.00 / 1.00
37.5-37.9 / 0.93 (0.79, 1.09) / 0.99 (0.82, 1.21) / 0.88 (0.77, 1.00)
38.0-38.4 / 0.91 (0.77, 1.08) / 1.28 (1.01, 1.61) / 0.87 (0.85, 1.00)
38.5-38.9 / 0.94 (0.76, 1.15) / 1.82 (1.34, 2.46) / 1.11 (0.91, 1.36)
39.0-39.4 / 1.81 (1.35, 2.43) / 1.43 (0.92, 2.23) / 1.65 (1.21, 2.24)
39.5-39.9 / 1.75 (1.03, 2.98) / 2.16 (0.99, 4.74) / 2.08 (1.26, 3.42)
40.0+ / 3.75 (1.88, 7.56) / 1.66 (0.73, 3.76) / 3.54 (1.79, 7.03)

Test of interaction: P<0.0001

Table 6: UK Data: Unadjusted odds ratio for acute hospital mortality for TBI/Stroke subgroups according to peak temperature (0.5°C bands)

Values are OR (95% CI)

Peak Temp (°C) / TBI / Ischaemic stroke / Subarachnoid/ intracranial haemorrhage
<36.0 / 6.48 (4.91,8.55) / 3.08 (1.82,5.21) / 10.43 (7.64,14.24)
36.0-36.4 / 2.28 (1.91,2.71) / 1.44 (1.13,1.85) / 2.56 (1.99,3.28)
36.5-36.9 / 1.45 (1.26,1.66) / 1.02 (0.85,1.23) / 1.21 (1.03,1.43)
37.0-37.4 / 1.00 / 1.00 / 1.00
37.5-37.9 / 0.95 (0.85,1.06) / 1.18 (0.95,1.48) / 1.24 (1.07,1.43)
38.0-38.4 / 1.07 (0.94,1.22) / 1.78 (1.41,2.24) / 1.55 (1.25,1.92)
38.5-38.9 / 1.27 (1.07,1.52) / 1.90 (1.37,2.65) / 2.20 (1.68,2.88)
39.0-39.4 / 2.52 (2.03,3.14) / 2.38 (1.59,3.56) / 3.47 (2.53,4.76)
39.5-39.9 / 4.05 (2.78,5.91) / 3.25 (1.60,6.60) / 6.61 (4.05,10.78)
40.0+ / 18.89 (10.68,33.42) / 19.76 (6.45,60.52) / 21.68 (12.95,36.30)

Test of interaction: P=0.001

Table 7: UK Data: Adjusted odds ratio for acute hospital mortality for the TBI/Stroke subgroups according to peak temperature (0.5°C bands)

Values are OR (95% CI)

Adjusted for predicted log odds of acute hospital mortality from ICNARC (2011) model (excluding weightings for temperature and sedation/GCS

Peak Temp (°C) / TBI / Ischaemic stroke / Subarachnoid/ intracranial haemorrhage
<36.0 / 4.83 (3.66,6.38) / 1.21 (0.68,2.15) / 5.18 (3.87,6.94)
36.0-36.4 / 2.23 (1.89,2.63) / 1.88 (1.28,2.78) / 2.16 (1.76,2.66)
36.5-36.9 / 1.51 (1.30,1.76) / 1.25 (1.01,1.56) / 1.45 (1.23,1.70)
37.0-37.4 / 1.00 / 1.00 / 1.00
37.5-37.9 / 0.94 (0.83,1.06) / 0.96 (0.74,1.24) / 1.02 (0.91,1.14)
38.0-38.4 / 0.97 (0.86,1.10) / 1.04 (0.81,1.35) / 1.00 (0.87,1.15)
38.5-38.9 / 1.05 (0.88,1.26) / 1.09 (0.75,1.58) / 1.21 (0.98,1.50)
39.0-39.4 / 1.70 (1.37,2.11) / 1.30 (0.80,2.11) / 1.66 (1.30,2.13)
39.5-39.9 / 2.49 (1.73,3.60) / 1.54 (0.67,3.53) / 2.99 (1.94,4.62)
40.0+ / 7.76 (4.34,13.89) / 9.77 (2.54,37.64) / 5.64 (3.28,9.71)

Test of interaction: P=0.014

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Intensive Care Medicine