Abstract
BackgroundHeat stroke (HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke (EHS).MethodsData were collected from a total of 170 exertional heat stroke (EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic (ROC) curve (AUC) were used to screen exertional heat stroke score (EHSS) parameters, including but not limited body temperature (T), Glasgow Coma Scale (GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.ResultsThrough screening with a series of methods, as described above, the present study determined 12 parameters – body temperature (T), GCS, pH, lactate (Lac), platelet count (PLT), prothrombin time (PT), fibrinogen (Fib), troponin I (TnI), aspartate aminotransferase (AST), total bilirubin (TBIL), creatinine (Cr) and acute gastrointestinal injury (AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low (EHSS< 20) and high scores (EHSS> 35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS > AUCSOFA > AUCAPACHE II.ConclusionA total of 12 parameters – T, GCS, pH, Lac, PLT, PT, Fib, TnI, AST, TBIL, Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.
Highlights
Heat stroke (HS) is a serious, life-threatening disease
One type of scoring system is suitable for various diseases, such as the Acute Physiology and Chronic Health Evaluation Simplified Acute Physiology Score II (II) (APACHE II), the Simplified Acute Physiology Score (SAPS II) and the Multiple Organ Dysfunction Score (MODS); the other type of scoring system is for a specific type of organ or disease, such as the Glasgow Coma Scale (GCS) for evaluating the degree of central nervous system (CNS) injury and the Ranson scale for evaluating the degree of injury of severe acute pancreatitis [7, 8]
When comparing the baseline level of exertional heat stroke (EHS) patients for establishing exertional heat stroke score (EHSS) to the baseline level of EHS patients for verifying the evaluation effectiveness of EHSS, there were no significant differences in various categories
Summary
Heat stroke (HS) is a serious, life-threatening disease. there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke (EHS). As a criterion for evaluating the severity of disease in intensive care units (ICUs), scoring systems have become important tools to help clinical physicians to make decisions [6]. The scoring systems that are used to evaluate the severity of EHS are mainly APACHE II and SOFA [9, 10]. EHS has a characteristic dispersed outbreak, which makes it very difficult for researchers to perform large sample size-based clinical studies [18]. This limitation may be the underlying reason that prevents the EHS scoring system from being established
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