Early Post-Rewarming Fever Is Associated with Favorable 6-Month Neurologic Outcomes in Patients with Out-Of-Hospital Cardiac Arrest: A Multicenter Registry Study

We investigated the association between post-rewarming fever (PRF) and 6-month neurologic outcomes in cardiac arrest survivors. This was a multicenter study based on a registry of comatose adult (&ge
18 years) out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management between October 2015 to December 2018. PRF was defined as peak temperature &ge
38.0 &deg
C within 72 h after completion of rewarming, and PRF timing was categorized as within 24, 24&ndash
48, and 48&ndash
72 h epochs. The primary outcome was neurologic outcomes at six months after cardiac arrest. Unfavorable neurologic outcome was defined as cerebral performance categories three to five. A total of 1031 patients were included, and 642 (62.3%) had unfavorable neurologic outcomes. PRF developed in 389 (37.7%) patients in 72 h after rewarming: within 24 h in 150 (38.6%), in 24&ndash
48 h in 155 (39.8%), and in 48&ndash
72 h in 84 (21.6%). PRF was associated with improved neurologic outcomes (odds ratio (OR), 0.633
95% confidence interval (CI), 0.416&ndash
0.963). PRF within 24 h (OR, 0.355
95% CI, 0.191&ndash
0.659), but not in 24&ndash
48 h or 48&ndash
72 h, was associated with unfavorable neurologic outcomes. Early PRF within 24 h after rewarming was associated with favorable neurologic outcomes.