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Elevated temperature may reflect the severity of brain injury rather than infection. The significance of admission temperature remains unclear, and hypothermia treatment lacks proven efficacy and safety. Administering paracetamol (acetaminophen) above 36.5 \u00b0C is considered safe, though its clinical benefit is modest. This study aimed to examine how admission temperature, peak temperature in the first 24 h, and temperature fluctuations affect three-month functional outcomes. Methods: We conducted a retrospective study using data from a prospective stroke registry, including 5883 patients (4830 with ischemic stroke [IS] and 1053 with hemorrhagic stroke [HS]). Temperature at admission, maximum temperature within the first 24 h, and the temperature increase during the first day were assessed. Patients with a temperature \u2265 37.5 \u00b0C received 3 g of paracetamol per day until normothermia was achieved. Results: Baseline temperature was not associated with 3-month functional outcomes. In IS patients, an increasing temperature during the first 24 h was associated with a 10-fold higher risk of poor functional outcome (sensitivity 81%, specificity 64%); whereas in HS, the risk increased sevenfold (sensitivity 88%, specificity 53%). The most reliable predictor of therapeutic response was the temperature increase on the first day, with sensitivities of 89% and 83%, and specificities of 84% and 71%, for IS and HS, respectively. Conclusions: An increase in temperature during the first 24 h, rather than a single measurement, is the most reliable temperature-based biomarker for predicting poor functional outcomes and guiding the initiation of antihyperthermic treatment.<\/jats:p>","DOI":"10.3390\/jcm15124786","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:04:04Z","timestamp":1781874244000},"page":"4786","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Dynamics of Body Temperature in Acute Stroke: Insights into Outcomes and Management"],"prefix":"10.3390","volume":"15","author":[{"given":"Crhistian-Mario","family":"Oblitas","sequence":"first","affiliation":[{"name":"Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Hospital Cl\u00ednico Universitario, R\u00faa Travesa da Choupana, s\/n, 15706 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2603-5271","authenticated-orcid":false,"given":"Mar\u00eda Luz","family":"Alonso-Alonso","sequence":"additional","affiliation":[{"name":"Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Hospital Cl\u00ednico Universitario, R\u00faa Travesa da Choupana, s\/n, 15706 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0345-2486","authenticated-orcid":false,"given":"Antonio J.","family":"Mosqueira","sequence":"additional","affiliation":[{"name":"Neuroradiology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5381-8557","authenticated-orcid":false,"given":"Manuel","family":"Rodr\u00edguez-Y\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, Hospital Cl\u00ednico Universitario, 15706 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iria","family":"L\u00f3pez-Dequidt","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, Hospital Cl\u00ednico Universitario de A Coru\u00f1a, 15006 A Coru\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8665-1039","authenticated-orcid":false,"given":"Francisco","family":"Campos","sequence":"additional","affiliation":[{"name":"Translational Stroke Laboratory (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9760-8690","authenticated-orcid":false,"given":"Tom\u00e1s","family":"Sobrino","sequence":"additional","affiliation":[{"name":"NeuroAging Laboratory (NEURAL), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red en Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6685-3001","authenticated-orcid":false,"given":"Jos\u00e9","family":"Castillo","sequence":"additional","affiliation":[{"name":"Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Hospital Cl\u00ednico Universitario, R\u00faa Travesa da Choupana, 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