Antipyretic Efcacy of Bromocriptine in Central Fever - an Exploratory Analysis

Antipyretic Efcacy of Bromocriptine in Central Fever: an Exploratory Analysis

Valeria Perez1

, Morgan McCreary2

, Lyndsay Sheperd1

, Tanna Nelson3

 and Kartavya Sharma2*

 

Abstract 

Background:  ‘Central’ fevers are thought to result from disruption of hypothalamic thermoregulatory pathways fol-lowing severe brain injuries. Bromocriptine, due to its central dopamine receptor agonism, has been hypothesized to have antipyretic efect in this setting. However, clinical evidence for this of-label use is limited to a few case reports. In this retrospective cohort study, we analyzed the efect of bromocriptine administration on body temperature in acute brain injury patients with suspected central fever.

Methods:  We screened a cohort of adult patients that received bromocriptine in the neurologic-intensive care unit of a tertiary care hospital between January 2018 and December 2021. Indication of central fever was ascertained by review of clinical documentation. A generalized additive mixed model (GAMM) was used to model temperature as a function of time relative to bromocriptine initiation. We adjusted for potential confounding due to the following covariates: temperature recording method (invasive vs surface), concurrent antipyretic administration within 8 h, and surface cooling device use within 4 h of temperature measurement. Temperature–time function was modeled using a cubic spline with k  = 10  knots.

Results:  A total of 33 patients were included in the analysis (14 women; mean age: 50 y, standard deviation 14 y). 

Median dose of bromocriptine was 7.5 mg (range 2.5–40) for a median of 13 d (range 5–160). Age and sex did not impact the function of temperature over time. Predicted temperatures were signifcantly (p  < 0.05) higher by 0.4 °C with invasive compared to surface recording methods, lower by 0.2 °C in the presence of cooling device use and lower by 0.1 °C with concurrent antipyretic use. On adjusted analysis with the GAMM, there was decline (p < 0.05)  in temperature following bromocriptine initiation by − 0.3 °C at 24 h, − 0.5 °C at 48 h, and − 0.7 °C at 72 h.

Conclusions:  Bromocriptine use was associated with modest but statistically signifcant decline in temperature, with nadir at 72 h post initiation. The fndings provide a data driven basis for prospective evaluation.

Keywords:  Bromocriptine, Fever, Brain injuries, Critical illness, Of-label use

LƯU Ý:

Tài liệu được chia sẻ bởi Anh "Quocphong Nguyen" Admin Group "Free Load Tài Liệu" và chỉ được dùng phục vụ mục đích học tập và nghiên cứu.

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Antipyretic Efcacy of Bromocriptine in Central Fever: an Exploratory Analysis

Valeria Perez1

, Morgan McCreary2

, Lyndsay Sheperd1

, Tanna Nelson3

 and Kartavya Sharma2*

 

Abstract 

Background:  ‘Central’ fevers are thought to result from disruption of hypothalamic thermoregulatory pathways fol-lowing severe brain injuries. Bromocriptine, due to its central dopamine receptor agonism, has been hypothesized to have antipyretic efect in this setting. However, clinical evidence for this of-label use is limited to a few case reports. In this retrospective cohort study, we analyzed the efect of bromocriptine administration on body temperature in acute brain injury patients with suspected central fever.

Methods:  We screened a cohort of adult patients that received bromocriptine in the neurologic-intensive care unit of a tertiary care hospital between January 2018 and December 2021. Indication of central fever was ascertained by review of clinical documentation. A generalized additive mixed model (GAMM) was used to model temperature as a function of time relative to bromocriptine initiation. We adjusted for potential confounding due to the following covariates: temperature recording method (invasive vs surface), concurrent antipyretic administration within 8 h, and surface cooling device use within 4 h of temperature measurement. Temperature–time function was modeled using a cubic spline with k  = 10  knots.

Results:  A total of 33 patients were included in the analysis (14 women; mean age: 50 y, standard deviation 14 y). 

Median dose of bromocriptine was 7.5 mg (range 2.5–40) for a median of 13 d (range 5–160). Age and sex did not impact the function of temperature over time. Predicted temperatures were signifcantly (p  < 0.05) higher by 0.4 °C with invasive compared to surface recording methods, lower by 0.2 °C in the presence of cooling device use and lower by 0.1 °C with concurrent antipyretic use. On adjusted analysis with the GAMM, there was decline (p < 0.05)  in temperature following bromocriptine initiation by − 0.3 °C at 24 h, − 0.5 °C at 48 h, and − 0.7 °C at 72 h.

Conclusions:  Bromocriptine use was associated with modest but statistically signifcant decline in temperature, with nadir at 72 h post initiation. The fndings provide a data driven basis for prospective evaluation.

Keywords:  Bromocriptine, Fever, Brain injuries, Critical illness, Of-label use

LƯU Ý:

Tài liệu được chia sẻ bởi Anh "Quocphong Nguyen" Admin Group "Free Load Tài Liệu" và chỉ được dùng phục vụ mục đích học tập và nghiên cứu.

LINK DOWNLOAD

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