Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage
Background Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. Me...
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| Veröffentlicht in: | Neurocritical care 2019-04, Vol.30 (2), p.244-250 |
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| creator | Swor, Dionne E. Thomas, Leena F. Maas, Matthew B. Grimaldi, Daniela Manno, Edward M. Sorond, Farzaneh A. Batra, Ayush Kim, Minjee Prabhakaran, Shyam Naidech, Andrew M. Liotta, Eric M. |
| description | Background
Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH.
Methods
We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38
°
C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at
p
≤ 0.2 were entered in a logistic regression model of being febrile within 14 days.
Results
There were 248 patients (median age 63 [54–74] years, 125 [50.4%] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec,
p
= 0.001). Lower HRV was associated with more febrile days (R = − 0.22,
p
|
| doi_str_mv | 10.1007/s12028-019-00684-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6474355</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2190494431</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-3688ec17e64e66b5ee49de259cf5f7a83e66c7d6317d061757e196f8e2bc03e13</originalsourceid><addsrcrecordid>eNp9UcuO1DAQtBCIfcAPcECWuHAJ-O34gjRa2Ie0EggBV8txOjNeJfFge3a0f4-HLMvjwMVuuaqrul0IvaDkDSVEv82UEdY2hJqGENWKZv8IHVMpVUOMoo8PtaCNMpwfoZOcbwhh2mj5FB1xoqXijByjuOqnkHOIM74Elwr-7Argby4F14UxlDscMl7lHH2oQI_3oWzwOdxCwu_rOcbtBHPBYcafXAm1zAvlai7JeUjQJTdW6SmmtHFreIaeDG7M8Pz-PkVfzz98Obtsrj9eXJ2trhsvtCgNV20LnmpQApTqJIAwPTBp_CAH7VpeX73uFae6J4pqqYEaNbTAOk84UH6K3i262103Qe_hMM9otylMLt3Z6IL9G5nDxq7jrVXVn0tZBV7fC6T4fQe52PpPHsbRzRB32TJqiDBC8IPXq3-oN3GX5rqeZYYaKQSVurLYwvIp5pxgeBiGEnvI0y552pqn_Zmn3deml3-u8dDyK8BK4AshV2heQ_rt_R_ZH6aBrdc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2919544157</pqid></control><display><type>article</type><title>Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><source>ProQuest Central</source><creator>Swor, Dionne E. ; Thomas, Leena F. ; Maas, Matthew B. ; Grimaldi, Daniela ; Manno, Edward M. ; Sorond, Farzaneh A. ; Batra, Ayush ; Kim, Minjee ; Prabhakaran, Shyam ; Naidech, Andrew M. ; Liotta, Eric M.</creator><creatorcontrib>Swor, Dionne E. ; Thomas, Leena F. ; Maas, Matthew B. ; Grimaldi, Daniela ; Manno, Edward M. ; Sorond, Farzaneh A. ; Batra, Ayush ; Kim, Minjee ; Prabhakaran, Shyam ; Naidech, Andrew M. ; Liotta, Eric M.</creatorcontrib><description>Background
Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH.
Methods
We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38
°
C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at
p
≤ 0.2 were entered in a logistic regression model of being febrile within 14 days.
Results
There were 248 patients (median age 63 [54–74] years, 125 [50.4%] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec,
p
= 0.001). Lower HRV was associated with more febrile days (R = − 0.22,
p
< 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87–0.97] with each msec increase in SDNN,
p
= 0.002).
Conclusions
HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-019-00684-w</identifier><identifier>PMID: 30756320</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aged ; Beta blockers ; Binomial distribution ; Blood pressure ; Cardiovascular disease ; Cerebral Hemorrhage - complications ; Cerebral Hemorrhage - physiopathology ; Critical Care Medicine ; Electrocardiography ; Female ; Fever ; Fever - etiology ; Fever - physiopathology ; Generalized linear models ; Heart rate ; Heart Rate - physiology ; Hematoma ; Hemorrhage ; Hospitalization ; Humans ; Intensive ; Intensive care ; Internal Medicine ; Ischemia ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Nervous system ; Neurology ; Original Work ; Parasympathetic Nervous System - physiopathology ; Patient Admission ; Patients ; Prospective Studies ; Regression analysis ; Statistical analysis ; Stroke ; Temperature ; Ventilators</subject><ispartof>Neurocritical care, 2019-04, Vol.30 (2), p.244-250</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-3688ec17e64e66b5ee49de259cf5f7a83e66c7d6317d061757e196f8e2bc03e13</citedby><cites>FETCH-LOGICAL-c474t-3688ec17e64e66b5ee49de259cf5f7a83e66c7d6317d061757e196f8e2bc03e13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-019-00684-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2919544157?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,776,780,881,21367,27901,27902,33721,33722,41464,42533,43781,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30756320$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Swor, Dionne E.</creatorcontrib><creatorcontrib>Thomas, Leena F.</creatorcontrib><creatorcontrib>Maas, Matthew B.</creatorcontrib><creatorcontrib>Grimaldi, Daniela</creatorcontrib><creatorcontrib>Manno, Edward M.</creatorcontrib><creatorcontrib>Sorond, Farzaneh A.</creatorcontrib><creatorcontrib>Batra, Ayush</creatorcontrib><creatorcontrib>Kim, Minjee</creatorcontrib><creatorcontrib>Prabhakaran, Shyam</creatorcontrib><creatorcontrib>Naidech, Andrew M.</creatorcontrib><creatorcontrib>Liotta, Eric M.</creatorcontrib><title>Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>Background
Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH.
Methods
We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38
°
C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at
p
≤ 0.2 were entered in a logistic regression model of being febrile within 14 days.
Results
There were 248 patients (median age 63 [54–74] years, 125 [50.4%] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec,
p
= 0.001). Lower HRV was associated with more febrile days (R = − 0.22,
p
< 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87–0.97] with each msec increase in SDNN,
p
= 0.002).
Conclusions
HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.</description><subject>Aged</subject><subject>Beta blockers</subject><subject>Binomial distribution</subject><subject>Blood pressure</subject><subject>Cardiovascular disease</subject><subject>Cerebral Hemorrhage - complications</subject><subject>Cerebral Hemorrhage - physiopathology</subject><subject>Critical Care Medicine</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Fever</subject><subject>Fever - etiology</subject><subject>Fever - physiopathology</subject><subject>Generalized linear models</subject><subject>Heart rate</subject><subject>Heart Rate - physiology</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Internal Medicine</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nervous system</subject><subject>Neurology</subject><subject>Original Work</subject><subject>Parasympathetic Nervous System - physiopathology</subject><subject>Patient Admission</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Regression analysis</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Temperature</subject><subject>Ventilators</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9UcuO1DAQtBCIfcAPcECWuHAJ-O34gjRa2Ie0EggBV8txOjNeJfFge3a0f4-HLMvjwMVuuaqrul0IvaDkDSVEv82UEdY2hJqGENWKZv8IHVMpVUOMoo8PtaCNMpwfoZOcbwhh2mj5FB1xoqXijByjuOqnkHOIM74Elwr-7Argby4F14UxlDscMl7lHH2oQI_3oWzwOdxCwu_rOcbtBHPBYcafXAm1zAvlai7JeUjQJTdW6SmmtHFreIaeDG7M8Pz-PkVfzz98Obtsrj9eXJ2trhsvtCgNV20LnmpQApTqJIAwPTBp_CAH7VpeX73uFae6J4pqqYEaNbTAOk84UH6K3i262103Qe_hMM9otylMLt3Z6IL9G5nDxq7jrVXVn0tZBV7fC6T4fQe52PpPHsbRzRB32TJqiDBC8IPXq3-oN3GX5rqeZYYaKQSVurLYwvIp5pxgeBiGEnvI0y552pqn_Zmn3deml3-u8dDyK8BK4AshV2heQ_rt_R_ZH6aBrdc</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Swor, Dionne E.</creator><creator>Thomas, Leena F.</creator><creator>Maas, Matthew B.</creator><creator>Grimaldi, Daniela</creator><creator>Manno, Edward M.</creator><creator>Sorond, Farzaneh A.</creator><creator>Batra, Ayush</creator><creator>Kim, Minjee</creator><creator>Prabhakaran, Shyam</creator><creator>Naidech, Andrew M.</creator><creator>Liotta, Eric M.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190401</creationdate><title>Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage</title><author>Swor, Dionne E. ; Thomas, Leena F. ; Maas, Matthew B. ; Grimaldi, Daniela ; Manno, Edward M. ; Sorond, Farzaneh A. ; Batra, Ayush ; Kim, Minjee ; Prabhakaran, Shyam ; Naidech, Andrew M. ; Liotta, Eric M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-3688ec17e64e66b5ee49de259cf5f7a83e66c7d6317d061757e196f8e2bc03e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Beta blockers</topic><topic>Binomial distribution</topic><topic>Blood pressure</topic><topic>Cardiovascular disease</topic><topic>Cerebral Hemorrhage - complications</topic><topic>Cerebral Hemorrhage - physiopathology</topic><topic>Critical Care Medicine</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Fever</topic><topic>Fever - etiology</topic><topic>Fever - physiopathology</topic><topic>Generalized linear models</topic><topic>Heart rate</topic><topic>Heart Rate - physiology</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Internal Medicine</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nervous system</topic><topic>Neurology</topic><topic>Original Work</topic><topic>Parasympathetic Nervous System - physiopathology</topic><topic>Patient Admission</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Regression analysis</topic><topic>Statistical analysis</topic><topic>Stroke</topic><topic>Temperature</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Swor, Dionne E.</creatorcontrib><creatorcontrib>Thomas, Leena F.</creatorcontrib><creatorcontrib>Maas, Matthew B.</creatorcontrib><creatorcontrib>Grimaldi, Daniela</creatorcontrib><creatorcontrib>Manno, Edward M.</creatorcontrib><creatorcontrib>Sorond, Farzaneh A.</creatorcontrib><creatorcontrib>Batra, Ayush</creatorcontrib><creatorcontrib>Kim, Minjee</creatorcontrib><creatorcontrib>Prabhakaran, Shyam</creatorcontrib><creatorcontrib>Naidech, Andrew M.</creatorcontrib><creatorcontrib>Liotta, Eric M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Swor, Dionne E.</au><au>Thomas, Leena F.</au><au>Maas, Matthew B.</au><au>Grimaldi, Daniela</au><au>Manno, Edward M.</au><au>Sorond, Farzaneh A.</au><au>Batra, Ayush</au><au>Kim, Minjee</au><au>Prabhakaran, Shyam</au><au>Naidech, Andrew M.</au><au>Liotta, Eric M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>30</volume><issue>2</issue><spage>244</spage><epage>250</epage><pages>244-250</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>Background
Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH.
Methods
We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1–4 h. We defined being febrile as having a temperature of ≥ 38
°
C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher’s exact, Mann–Whitney U, or Spearman’s rho correlation tests. Variables associated with fever at
p
≤ 0.2 were entered in a logistic regression model of being febrile within 14 days.
Results
There were 248 patients (median age 63 [54–74] years, 125 [50.4%] female, median ICH Score 1 [0–2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08–3.60] vs. 2.55 [1.58–5.72] msec,
p
= 0.001). Lower HRV was associated with more febrile days (R = − 0.22,
p
< 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87–0.97] with each msec increase in SDNN,
p
= 0.002).
Conclusions
HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30756320</pmid><doi>10.1007/s12028-019-00684-w</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Neurocritical care, 2019-04, Vol.30 (2), p.244-250 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings; ProQuest Central |
| subjects | Aged Beta blockers Binomial distribution Blood pressure Cardiovascular disease Cerebral Hemorrhage - complications Cerebral Hemorrhage - physiopathology Critical Care Medicine Electrocardiography Female Fever Fever - etiology Fever - physiopathology Generalized linear models Heart rate Heart Rate - physiology Hematoma Hemorrhage Hospitalization Humans Intensive Intensive care Internal Medicine Ischemia Male Medicine Medicine & Public Health Middle Aged Mortality Nervous system Neurology Original Work Parasympathetic Nervous System - physiopathology Patient Admission Patients Prospective Studies Regression analysis Statistical analysis Stroke Temperature Ventilators |
| title | Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage |
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