Periprocedural body temperature and clinical outcomes after successful reperfusion in large vessel occlusion stroke

Functional recovery remains heterogeneous among patients with large-vessel occlusion stroke, even after successful reperfusion. Body temperature may constitute a potentially modifiable physiological factor associated with functional outcome. In particular, whether clinical factors, including baseline stroke severity, modify this temperature-outcome association remains uncertain.

We retrospectively analyzed 219 patients with large-vessel occlusion acute ischemic stroke (LVO-AIS) who underwent EVT and achieved successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3. Pre and post-EVT body temperatures were recorded. The primary outcome was favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days. Logistic regression analyses and exploratory subgroup analyses were performed to evaluate the association between body temperature and clinical outcomes.

Among the 219 included patients, 104 (47.5%) achieved favorable functional outcome at 90 days. Pre-EVT temperature was not significantly associated with functional outcome. In unadjusted analysis, each 1 °C increase in post-EVT temperature was associated with lower odds of favorable functional outcome (OR, 0.40; 95% CI, 0.20-0.79; P = 0.01) and higher odds of mortality (OR, 2.02; 95% CI, 1.11-3.66; P = 0.02). However, these associations were attenuated after multivariable adjustment (adjusted OR, 0.47; 95% CI, 0.19-1.15; P = 0.10; adjusted OR, 1.22; 95% CI, 0.49-3.02; P = 0.67). In exploratory subgroup analyses, a potential association between higher post-EVT temperature and lower odds of favorable outcome was observed in patients with baseline NIHSS ≤ 15 (adjusted OR, 0.29; 95% CI, 0.08-0.98; P = 0.047), although the interaction was not statistically significant (P for interaction = 0.64).

In this exploratory study, body temperature was not independently associated with functional outcome in the overall cohort. Although a potential association between higher post-EVT temperature and unfavorable outcome was observed in patients with baseline NIHSS ≤ 15, the interaction was not significant. This finding is hypothesis-generating and warrants prospective validation with pre-specified subgroup analyses.