Circulatory Failure among Hospitalizations for Heatstroke in the United States.

Tarun Bathini,Wisit Kaewput,Boonphiphop Boonpheng,Api Chewcharat,Tananchai Petnak,Charat Thongprayoon,Saraschandra Vallabhajosyula,Wisit Cheungpasitporn,Narut Prasitlumkum,Ronpichai Chokesuwattanaskul

doi:10.3390/medicines7060032

Abstract

Background: This study aimed to assess the risk factors and the association of circulatory failure with treatments, complications, outcomes, and resource utilization in hospitalized patients for heatstroke in the United States. Methods: Hospitalized patients with a principal diagnosis of heatstroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Circulatory failure, defined as any type of shock or hypotension, was identified using hospital diagnosis codes. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without circulatory failure were compared. Results: A total of 3372 hospital admissions primarily for heatstroke were included in the study. Of these, circulatory failure occurred in 393 (12%) admissions. Circulatory failure was more commonly found in obese patients, but less common in older patients aged ≥60 years. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with circulatory failure. Hyperkalemia, hypocalcemia, metabolic acidosis, metabolic alkalosis, sepsis, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, liver failure, neurological failure, and hematologic failure were associated with circulatory failure. The in-hospital mortality was 7.1-times higher in patients with circulatory failure. The length of hospital stay and hospitalization costs were higher when circulatory failure occurred while in the hospital. Conclusions: Approximately one out of nine heatstroke patients developed circulatory failure during hospitalization. Circulatory failure was associated with various complications, higher mortality, and increased resource utilizations.

Highlights

Among all heat-related illness, heatstroke is the most severe spectrum of diseases defined by a condition in which the core body temperature exceeds 40 ◦ C following a tremendous environmental heat load that overrides the body’s heat dissipation efforts [1]; it is accompanied by clinical central nervous system dysfunction and/or other organ failures [2]
This study aimed to assess the risk factors and the association of circulatory failure with treatments, complications, outcomes, and resource use in patients hospitalized for heatstroke in the U.S
A total of 3372 hospitalized heatstroke patients were included in analysis

Summary

Introduction

Among all heat-related illness, heatstroke is the most severe spectrum of diseases defined by a condition in which the core body temperature exceeds 40 ◦ C following a tremendous environmental heat load that overrides the body’s heat dissipation efforts [1]; it is accompanied by clinical central nervous system dysfunction and/or other organ failures [2]. Classic heatstroke is commonly found among the elderly whose thermoregulation mechanism is compromised. It is caused by an imbalance between the absorption of environmental heat and heat dissipation. Exertional heatstroke generally occurs among healthy young people who have engaged in strenuous physical activity during periods of high temperature and humidity [4,5]. This heavy activity causes excessive heat production, which overwhelms the heat-loss mechanism [6]. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with circulatory failure

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