Adverse Effect of Neurogenic, Infective, and Inﬂammatory Fever on Acutely Injured Human Spinal Cord

Journal of Neurotrauma, 2023 · DOI: 10.1089/neu.2023.0026 · Published: December 1, 2023

Simple Explanation

This study investigates the impact of different types of fever (neurogenic, inflammatory, and infective) on the injured spinal cord in patients with acute spinal cord injuries. The study found that all three types of fever are associated with metabolic stress in the injured spinal cord. Infective fever was particularly detrimental due to increased inflammation. The research suggests that accurately diagnosing the type of fever, especially neurogenic fever, can help avoid unnecessary antibiotic use and improve patient management after spinal cord injury.

Study Duration

September 2016 and December 2021

Participants

86 patients with acute, severe traumatic spinal cord injuries (TSCIs; American Spinal Injury Association Impairment Scale (AIS), grades A–C)

Evidence Level

Not specified

Key Findings

1
High fever occurred in 76.7% of patients with acute, severe traumatic spinal cord injuries.
2
Neurogenic fever only occurred with injuries rostral to vertebral level T4.
3
Infective fever is associated with elevated levels of pro-inflammatory cytokines/chemokines in the spinal cord.

Research Summary

This study evaluated the effects of neurogenic, inflammatory, and infective fevers on acutely injured human spinal cords, using data from 86 patients with severe traumatic spinal cord injuries. The findings indicate that all three fever types are detrimental to the injured spinal cord, leading to reduced tissue glucose and oxygen, and increased lactate to pyruvate ratio. The study also suggests a method to differentiate neurogenic from non-neurogenic fever using clinical characteristics, which may help reduce unnecessary antibiotic use.

Practical Implications

Improved Fever Management

Accurate diagnosis of fever type can lead to more targeted treatment strategies, potentially improving patient outcomes.

Reduced Antibiotic Use

Distinguishing neurogenic fever can help avoid unnecessary antibiotic administration, limiting antibiotic resistance.

Enhanced Monitoring Strategies

Injury site monitoring can guide patient management and help determine how the spinal cord responds to injury.

Study Limitations

1
The study shows associations, not causality, requiring further research to prove that treating fever improves outcome.
2
It is unclear if the cytokines/chemokines are produced locally or enter the cord from the circulation.
3
The method of distinguishing neurogenic from non-neurogenic fever needs external validation.

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