Heat Stroke Patients Research Articles

Prediction of the impact of climate change on the number of heatstroke patients in Tokyo, Japan with heat-adaptation effects

Background and Aim: Heatstroke has become a serious issue in Japan. To plan future adaptation measures, it is essential to understand to what extent the number of heatstroke patients will increase. Previous studies have predicted the number of heatstroke patients; however, they did not consider the effect of heat-adaptation. In this study, we conducted a future prediction study taking the effect of heat-adaptation into consideration. Methods: Japan, with its long north-south range, has a variety of climates, and it is necessary to explore its heat-adaptation effects. Our previous study showed that there was a positive correlation between the wet bulb globe temperature (WBGT) value at which heatstroke patients start to increase (WBGT threshold) and regional climate (average daily maximum WBGT between May and September: RCWBGT). Using the relationship, we translated this geographical effect of heat-adaptation to temporal adaptation by shifting the WBGT threshold to a higher side when the RCWBGT increases in the future owing to climate change. We focused on the age groups of 65+ yr, constituting the most vulnerable age group. Five future climate change scenarios and RCP8.5 scenario were adopted. All the data utilized in this study were public domain data and are available from the corresponding website. Results: In Tokyo, the number of heatstroke patients by mid-21st century will be 2.2 times as high as that of heatstroke patients at present and 6.9 times by the end of the century without heat-adaptation; however, the corresponding numbers will be 1.4 times and 2.5 times, respectively, with heat-adaptation. Conclusions: The increase in the number of heatstroke patients was projected to substantially reduce owing to the effect of heat-adaptation. Acknowledgement: This work was supported by the Climate Change Adaptation Research Program of the National Institute for Environmental Studies. Keywords: Climate change; Wet bulb globe temperature; Heatstroke; Impact assessment

Diagnostic Significance of Combined Calcitoninogen, Platelet, and D-Dimer Assay in Severe Heatstroke: with Clinical Data Analysis of 70 Patients with Severe Heatstroke.

The significance of calcitoninogen detection among inpatients was discussed by analyzing the clinical characteristics of severe heatstroke (HS). HS patients who were admitted to the Second Hospital of Nantong University, Jiangsu Province, China, between July 1, 2015, and October 30, 2020, were reviewed. Patients' clinical characteristics and laboratory data were recorded, and they were divided into three groups, that is, a control group (heat cramps and heat exhaustion), an exertional HS (EHS) group, and a classical HS (CHS) group to compare the differences among them. Receiver operating characteristic (ROC) curves were plotted to evaluate patients' clinical utility. (1) The body temperatures in the EHS and CHS groups were significantly higher than in the control group (all p < 0.05). (2) The D-dimer (DD), procalcitonin (PCT), and Acute Physiology and Chronic Health Evaluation (APACHE) II score of the EHS group were significantly higher compared with the control and CHS groups (all p < 0.05); the platelets (PLT), C-reactive protein (CRP), blood sodium (Na), and intravenous glucose (GLU) of the EHS group were lower than in the control and CHS groups (all p < 0.05). (3) The ROC curve analysis showed the performance results for DD (area under the curve [AUC] 0.670, 95% confidence interval [CI] 0.547-0.777), PCT (AUC 0.705, 95% CI 0.584-0.808), and PLT (AUC 0.791, 95% CI 0.677-0.879). The sensitivity was 40.48%, 100%, and 73.81%, and the specificity was 96.43%, 32.14%, and 78.57%, respectively. Using three combined analyses, an elevated AUC of 0.838, 95% CI 0.731-0.916, with a sensitivity of 71.43% and a specificity of 85.71%, respectively, was revealed. Patients in the EHS group had higher DD, PCT, and APACHE II values, whereas PLT, CRP, Na, and GLU were reduced. The apparent decrease in the PLT, as well as the increase in PCT and DD values, could be considered as early sensitivity indicators of severe HS. A combined test of these three indicators presented significant diagnostic value for detecting severe cases of HS.

Biomarkers of heatstroke-induced organ injury and repair.

What is the topic of this review? The status and potential role of novel biological markers (biomarkers) that can help identify the patients at risk of organ injury or long-term complications following heatstroke. What advances does it highlight? Numerous biomarkers were identified related to many aspects of generalized heatstroke-induced cellular injury and tissue damage, and heatstroke-provoked cardiovascular, renal, cerebral, intestinal and skeletal muscle injury. No novel biomarkers were identified for liver or lung injury. Classic and exertional heatstroke cause acute injury and damage across numerous organ systems. Moreover, heatstroke survivors may sustain long-term neurological, cardiovascular and renal complications with a persistent risk of death. In this context, biomarkers, defined as biological samples obtained from heatstroke patients, are needed to detect early organ injury, and predict outcomes to develop novel organ preservation therapeutic strategies. This narrative review provides preliminary insights that will guide the development and future utilization of these biomarkers. To this end, we have identified numerous biomarkers of widespread heatstroke-associated cellular injury, tissue damage and repair (extracellular heat shock proteins 72 and 60, high mobility group box protein 1, histone H3, and interleukin-1α), and other organ-specific biomarkers including those related to the cardiovascular system (cardiac troponin I, endothelium-derived factors, circulation endothelial cells, adhesion molecules, thrombomodulin and von Willebrand factor antigen), the kidneys (plasma and urinary neutrophil gelatinase-associated lipocalin), the intestines (intestinal fatty acid-binding protein 2), the brain (serum S100β and neuron-specific enolase) and skeletal muscle (creatine kinase, myoglobin). No specific biomarkers have been identified so far for liver or lung injury in heatstroke. Before translating the identified biomarkers into clinical practice, additional preclinical and clinical prospective studies are required to further understand their clinical utility, particularly for the biomarkers related to long-term post-heatstroke health outcomes.

Immune Cells Characteristics and Their Prognostic Effects in Exertional Heatstroke Patients: A Retrospective Cohort Study.

BackgroundExertional heatstroke (EHS) remains a major problem for those who take strenuous physical activity. Inflammation and immune dysfunction were thought to be crucial to the pathophysiological process of heatstroke. The present study was aimed to investigate the dynamic changes of the immune cells in patients with EHS and determine their prognostic effects to provide the clinical evidence of the above process.MethodsThis single-center retrospective cohort study collected all patients with EHS admitted to the intensive care unit (ICU) of the General Hospital of Southern Theater Command of PLA from October 2008 to May 2019. The dynamic changes of the main immune cell count and ratio were collected, including white blood cell (WBC), neutrophil, monocyte, and lymphocyte. The neutrophil-to-lymphocyte ratios (NLR) were calculated by the neutrophil count/lymphocyte count × 100%. The main outcome was 90-day mortality.ResultsA total of 189 patients were enrolled. For survivors, after 24 h, the WBC and neutrophil counts began to decrease, and they were back to normal in 72 h. In addition, the lymphocyte counts were within normal limits all the time. For non-survivors, the WBC and neutrophil counts were continuous over the normal range, while the lymphocyte count and the ratio began to decrease after 24 h and were continuously low in the following days. Receiver operating characteristic (ROC) curves analysis showed that increased neutrophils and decreased lymphocytes were associated with the poor prognosis of the patients. A prediction model based on immune cell counts and ratios was constructed, and the lymphocyte count was accounted for the maximum weight.ConclusionsIn patients with EHS, increased neutrophils and decreased lymphocytes were associated with the poor prognosis. The lymphocyte count at 72 h after admission was the most important prognostic factor.

Development and evaluation of a predictive nomogram for survival in heat stroke patients: a retrospective cohort study.

This study aimed to establish an effective nomogram to predict the survival of heat stroke (HS) based on risk factors. This was a retrospective, observational multicenter cohort study. We analyzed patients diagnosed with HS, who were treated between May 1 and September 30, 2018 at 15 tertiary hospitals from 11 cities in Northern China. Among the 175 patients, 32 patients (18.29%) died before hospital discharge. After the univariate analysis, mechanical ventilation, initial mean arterial pressure <70 mmHg, maximum heart rate, lab results on day 1 (white blood cell count, alanine aminotransferase, creatinine), and Glasgow admission prediction score were included in multivariate analysis. Multivariate Cox regression showed that invasive ventilation, initial mean arterial pressure <70 mmHg (1 mmHg=0.133 kPa), and Glasgow admission prediction score were independent risk factors for HS. The nomogram was established for predicting 7-d and 14-d survival in the training cohort. The nomogram exhibited a concordance index (C-index) of 0.880 (95% confidence interval [95% CI] 0.831-0.930) by bootstrapping validation (B=1,000). Furthermore, the nomogram performed better when predicting 14-d survival, compared to 7-d survival. The prognostic index cut-off value was set at 2.085, according to the operating characteristic curve for overall survival prediction. The model showed good calibration ability in the internal and external validation datasets. A novel nomogram, integrated with prognostic factors, was proposed; it was highly predictive of the survival in HS patients.

Prediction of the number of heatstroke patients transported by ambulance in Japan’s 47 prefectures: proposal of heat acclimatization consideration

The incidence of heatstroke is affected by various meteorological variables. However, previous studies in Japan have mainly investigated and adopted a single temperature metric or composite index for their analyses. Herein, we conducted a time series study through multivariate analysis of different weather conditions simultaneously, in order to analyze the relative importance of meteorological variables to determine the number of heatstroke patients transported by ambulance in all of Japan’s 47 prefectures. We proposed a method that considers heat acclimatization, which has been found to impact the heatstroke, by manipulating certain meteorological variables. For the heatstroke data, we utilized the secondary data provided by the Fire and Disaster Management Agency, Japan. The time period considered was from May 2015 to September 2019. All calculations were performed using R 3.5.1. For the analysis, the machine learning method of random forest (RF) was applied. The results showed that the relative temperature (RelTemp), which represents heat acclimatization, had the highest ranking among all the meteorological variables studied. Then, we developed the exponential model and the RF model to predict the number of heatstroke patients transported by ambulance by adopting the highly ranked meteorological variables including RelTemp as explanatory variables. To confirm the effectiveness of heat acclimatization, we also developed the exponential model and the RF model both without RelTemp (instead, with maximum temperature). According to the results, the R2 values of the exponential and the RF models, including RelTemp, were 0.76 and 0.74, respectively, and those of the exponential and the RF models, excluding RelTemp, were 0.68 and 0.67, respectively. We confirmed the effectiveness of considering heat acclimatization via RelTemp and found that the exponential model with RelTemp provided the higher accuracy. Better predictions by the exponential model with RelTemp would contribute to better preemptive allocation of ambulances and medical staff in medical facilities.

Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion.

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.

Association Between Platelet Levels on Admission and 90-day Mortality in Patients With Exertional Heatstroke, a 10 Years Cohort Study.

Background: Heatstroke is a common clinical symptom in summer with high mortality requiring identification of appropriate and rapid methods of assessment.Method: This is a retrospective study that included the recent 10 years clinical data of heatstroke patients. A total of n = 186 patients were included in this study and grouped based on platelet (PLT) abnormality observed on admission.Results: In the study group, n = 120 patients (64.5%) patients had normal PLT and n = 66 patients (35.5%) had abnormal PLT. Compared with PLT-normal group, PLT-abnormal group had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores [median 15.0 (IQR 11.5–21.5) vs. 9.0 (IQR 7.0–12.5)] and SOFA scores [median 6.0 (IQR 4.0–10.0) vs. 2.0 (IQR 2.0–4.0)], lower Sequential Organ Failure Assessment (GCS)[median 8.0 (IQR 5.0–12.0) vs. 13.0 (IQR 9.0–14.0)]. The PLT-abnormal group had severe organ damage, including damage to the coagulation system, liver, and kidney (all p < 0.05). Significant differences were noted in 90-day survival between the two groups even after correction for Age, GCS, White blood cell count (WBC), Neutrophil, International normalized ratio (INR), Activated partial thromboplastin time (APTT), Procalcitonin (PCT), Alanine aminotransferase (ALT), Creatine (CR), D-Dime (D-D) (Before correction P < 0.001; After correction P = 0.009).The area under the ROC curve for the prediction of mortality based on PLT was 80.7% (95% CI 0.726–0.888, P < 0.001), the optimal cutoff value was 94, the sensitivity was 77.3%, and the specificity was 82.6%.Conclusion: Patients with heatstroke with platelet abnormalities during admission have more severe organ impairment and a lower 90-day survival rate even when adjusted for other factors.

Assessing the Climatological Relationship between Heatstroke Risk and Heat Stress Indices in 47 Prefectures in Japan

This study provides a decade-long link between summer heatstroke incidence and certain heat stress indices in 47 prefectures of Japan. The results for each prefecture were determined from the age-adjusted heatstroke incidence rate (TRadj) with heatstroke patients transported by ambulance, as well as from the daily maximum temperature (TEMPmax), maximum wet-bulb globe temperature (WBGTmax), and maximum universal thermal climate index (UTCImax) recorded from July to September of 2010–2019. The UTCImax relatively increased the vulnerability in many prefectures of northern Japan more distinctly than the other indices. In the following analysis, the ratio of the TRadj of the hottest to coolest months using the UTCImax was defined as the heatstroke risk of the hottest to coolest (HRHC). Overall, the HRHC varied approximately from 20 to 40 in many prefectures in the past decade. In contrast, for the same analysis performed in each month, HRHC ratios in July and August fell within 2–4 in many prefectures, whereas in September, the average and maximum HRHC ratios for all prefectures were 7.0 and 32.4, respectively. This difference can be related to the large difference in UTCImax between the maximum and minimum for a decade.

Lack of lymphocytes exacerbate heat stroke severity in male mice through enhanced inflammatory response

Though it has long been thought that the immune system is implicated in the pathophysiology of heat stroke, the underlying mechanisms are still poorly understood. As it has been reported in the literature that lymphocyte disturbance occurs in heat stroke patients or animals, we attempted to seek experimental evidence to define the role of lymphocytes in the pathophysiology of heat stroke. In our study, we used male Balb/c mice to establish a passive heat stroke model. We found that lymphocyte-deficient Severe combined immunodeficient (SCID) mice exposed to heat stress exhibited exacerbated heat stroke severity, which could be indicated by increased rates of mortality and serum levels of inflammatory cytokines compared to wildtype control mice. We further showed, through the depletion of T lymphocytes in wildtype mice and the transfer of wildtype lymphocytes into SCID mice, respectively, that T lymphocytes were both necessary and sufficient to alleviate the severity of heat stroke by inhibiting the early inflammatory response. Moreover, we found that the severity of heat injuries in heat-stressed wildtype mice showed great inter-individual variability, and the early number of T lymphocytes could be negatively associated with the severity of heat stroke. Our results suggest that lack of T lymphocytes could exacerbate the severity of heat stroke by augmenting inflammatory response, and the early circulating T lymphocytes may serve as a potential biomarker for the diagnosis of heat stroke.

Characteristics and Outcome of Exertional Heatstroke Patients Complicated by Acute Hepatic Injury.

Characteristics and Outcome of Exertional Heatstroke Patients Complicated by Acute Hepatic Injury.

Heatstroke predictions by machine learning, weather information, and an all-population registry for 12-hour heatstroke alerts

This study aims to develop and validate prediction models for the number of all heatstroke cases, and heatstrokes of hospital admission and death cases per city per 12 h, using multiple weather information and a population-based database for heatstroke patients in 16 Japanese cities (corresponding to around a 10,000,000 population size). In the testing dataset, mean absolute percentage error of generalized linear models with wet bulb globe temperature as the only predictor and the optimal models, respectively, are 43.0% and 14.8% for spikes in the number of all heatstroke cases, and 37.7% and 10.6% for spikes in the number of heatstrokes of hospital admission and death cases. The optimal models predict the spikes in the number of heatstrokes well by machine learning methods including non-linear multivariable predictors and/or under-sampling and bagging. Here, we develop prediction models whose predictive performances are high enough to be implemented in public health settings.

Effect of an educational program about heat stroke patients' outcomes

Effect of an educational program about heat stroke patients' outcomes

Design and application of a split first aid suit for heat stroke

In the trend of global warming and the increasing number of participating in high-intensity sports, the incidence of heat stroke is increasing year by year. Heat stroke is categorized to the class of heat emergent diseases. If there is no quick and effective treatment, the mortality rate is as high as 50%. Early, rapid, and effective cooling is the key point in the treatment of heat stroke. The early recognition and rapid lowering the core body temperature to 38.9 centigrade within 30 minutes of exertional heat stroke results in better clinical outcome with the fewest complications, however, the "golden 30 minutes" is far from enough to complete emergency transport and evaluation. Therefore, it is urgent to develop a first aid suit for heat stroke suitable for field treatment and transportation, so as to achieve the treatment goal of early rapid and effective cooling in field environment. For this purpose, the medical staff of the department of critical care medicine of the Eighth Medical Center of the Chinese People's Liberation Army General Hospital designed and developed the split first aid suit, which is suitable for heat stroke patient in the harsh environment lacking medical supplies and water during transportation. The medical staff who designed the first aid suit obtained a National Utility Model Patent of China (ZL 2020 2 1627326.4). The split heat stroke first aid suit is composed of four main parts: a sleeveless coat, a hat, sleeves and wrapped pants. All of them are made by temperature changeable fabric which is a composite material made by fine porous silica gel particles and potassium nitrate. The cuffs of the sleeveless top of the clothes part and the sleeves are connected as a whole by the connecting pieces; and the front end of the hem of the clothes part and the wrapped trousers are also connected as a whole by the connecting pieces, which is convenient for fixing and transportation. In order to control the water injection quantity, the water injection bag and the corresponding components are designed to ensure the same amount of water can be injected to the heat stroke first aid suit at each time, so the same frigorific effect can be attainable. The service temperature is 14-18 centigrade, so it will not cause local frostbite to patients when used for a long time. This split-type first aid suit can be used in the movement, rescue and transportation of heat stroke patients. It is easy to carry and use with accurate cooling effect with low cost, moreover, it is reusable and can be widely used for on-site emergency and transportation of heat stroke patients.

Characteristics and Outcome of Exertional Heatstroke Patients Complicated by Acute Hepatic Injury: A Cohort Study.

Background and AimsExertional heatstroke (EHS) is associated with strenuous physical activity in hot environments. The present study aimed to investigate dynamic changes of hepatic function indices in EHS patients and determine risk factors for death.MethodsThis single-center retrospective cohort study considered all patients with EHS admitted to the intensive care unit at the General Hospital of Southern Theater Command of PLA from October 2008 to May 2019. Data on general characteristics, organ function parameters, and the 90-day outcome of enrolled patients were collected. Hepatic indices were collected dynamically, and patients with acute hepatic injury (AHI) were identified by plasma total bilirubin (TBIL) ≥34.2 µmol/L and an international normalized ratio ≥1.5, or with any grade of hepatic encephalopathy.ResultsIn patients who survived, TBIL, alanine aminotransferase and aspartate aminotransferase were increased at 24 h, peaked at 2–3 days, and began to decrease at 5 days. In non-survivors, TBIL continuously increased post-admission. The area under the receiver operating characteristic curve for the prediction of mortality based on sequential organ failure assessment (SOFA) scores was 89.8%, and the optimal cutoff value was 7.5. Myocardial injury and infection were identified as independent risk factors for death in EHS patients with AHI.ConclusionsIn EHS patients, hepatic dysfunction usually occurred within 24 h. Patients with AHI had more severe clinical conditions, and significantly increased 90-day mortality rates. SOFA scores over 7.5, complicated with myocardial injury or infection, were found to be risk factors for death in EHS patients with AHI.

Heat health risk assessment analysing heatstroke patients in Fukuoka City, Japan.

BackgroundClimate change, as a defining issue of the current time, is causing severe heat-related illness in the context of extremely hot weather conditions. In Japan, the remarkable temperature increase in summer caused by an urban heat island and climate change has become a threat to public health in recent years.MethodsThis study aimed to determine the potential risk factors for heatstroke by analysing data extracted from the records of emergency transport to the hospital due to heatstroke in Fukuoka City, Japan. In this regard, a negative binomial regression model was used to account for overdispersion in the data. Age-structure analyses of heatstroke patients were also embodied to identify the sub-population of Fukuoka City with the highest susceptibility.ResultsThe daily maximum temperature and wet-bulb globe temperature (WBGT), along with differences in both the mean temperature and time-weighted temperature from those of the consecutive past days were detected as significant risk factors for heatstroke. Results indicated that there was a positive association between the resulting risk factors and the probability of heatstroke occurrence. The elderly of Fukuoka City aged 70 years or older were found to be the most vulnerable to heatstroke. Most of the aforementioned risk factors also encountered significant and positive associations with the risk of heatstroke occurrence for the group with highest susceptibility.ConclusionThese results can provide insights for health professionals and stakeholders in designing their strategies to reduce heatstroke patients and to secure the emergency transport systems in summer.

Experience of treating batches of exertional heat stroke patients in military training

To explore the process and segments of intense treatment of patients suffered from exertional heat stroke (EHS), and to provide the experience and guidance for treating batches of EHS patients. A retrospective study of the curing process of eight EHS patients admitted to the Eighth Medical Center of Chinese PLA General Hospital on May 18th, 2019 was conducted, including onsite treatment and subsequent transshipment to hospital for treatment. Based on the medical history with high-intensity exercise and the clinical manifestation of central nervous system dysfunction, the eight patients were quickly diagnosed as EHS on the site, and were immediately rehydrated and attained the systematic cooling. An emergency plan for the treatment of batches of patients was initiated instantly for quick medical evacuation and care, and the patients were quickly transferred to the Eighth Medical Center of Chinese PLA General Hospital. A therapeutic principle was strictly followed, concerning the transshipment accompanied by systematic cooling while the medical evacuation and care, therapeutic preparation and immediate opening of the green channel were started up in the hospital. Sticking to the plan of allocating patients vs. nurses vs. doctor by 1:3:1, enough persons were dispatched. Ventilators, hemofiltration machines and ice blanket machines were prepared. Through the professional diagnosis and treatment in the emergency department, the patients were transferred to the ICU department. The relevant medical departments were coordinated with the centralization of the ICU department. The vital signs of patients were monitored closely. The titration and precise treatment were implemented, based on the changes in blood routine examination, blood biochemical indexes, blood clotting function, and blood gas analysis. The continuous renal replacement therapy (CRRT) was performed for four patients, the ice blanket machine cooling therapy for two patients, and the tracheal intubation and mechanical ventilation for one patient. Low molecular weight heparin sodium anticoagulant treatment was used in one patient with the diffuse intravascular coagulation (DIC) on the basis of coagulation factors such as plasmas and fibrinogens supplementation. The function of the damaged organs was significantly improved in 5-11 days. Eight patients were finally transferred out from ICU department. All patients were recovered and discharged after 11-20 days. A normative treatment process (rapid recognition on the site, rapid cooling, rapid and safe medical evacuation, in-hospital multidisciplinary collaboration) combined bundles of therapeutic strategy such as systematic cooling and rehydration, CRRT, and supplying the coagulation factors while anticoagulation treatment can provide a strong guarantee for rescuing batches of EHS patients and achieve satisfactory treatment outcomes.

Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis

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.

Long-Term Cardiovascular Diseases of Heatstroke: A Delayed Pathophysiology Outcome.

Heatstroke, defined as an elevated core body temperature above 40°C accompanied by altered mental status (e.g., confusion, disorientation, seizure and coma), is the most severe and life-threatening condition in the spectrum of heat-related illnesses. Heatstroke patients may present with multi-organ dysfunction, but with rapid cooling and organ failure management, a full recovery often occurs within weeks. Long-term impairment is rare, with neurological impairment occurring most frequently. Despite an abundance of research on the persistent neurological and hepatic impairments, our knowledge of the long-term cardiovascular events in patients with heatstroke history is poor. We wondered whether heatstroke leads to cardiovascular diseases long after full recovery. Using Pubmed, Web of Science and Scopus, we gathered cohort studies looking at cardiovascular disease incidence or mortality as an outcome, including heatstroke animal studies. Based on the available literature, we found that a history of heatstroke is associated with an increased risk of cardiovascular diseases, including ischemic heart disease, heart failure and atrial fibrillation. Delayed metabolic disturbances occurring in exertional heatstroke mice are linked to the formation of atherosclerosis and the development of heart failure. These processes provide potential pathophysiological pathways leading to ischemic heart disease and heart failure in heatstroke patients. Our findings may massively impact our understanding of heatstroke recovery and the follow up of heatstroke patients. Therefore larger, more adequately powered cohort studies with cardiovascular disease as an outcome, in tandem with animal studies examining the underlying pathophysiology, are required to confirm or reject these findings and answer the proposed questions.

Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States.

This study aims to evaluate the risk factors and the association of acute kidney injury with treatments, complications, outcomes, and resource utilization in patients hospitalized for heat stroke in the United States. Hospitalized patients from years 2003 to 2014 with a primary diagnosis of heat stroke were identified in the National Inpatient Sample dataset. End stage kidney disease patients were excluded. The occurrence of acute kidney injury during hospitalization was identified using the hospital diagnosis code. The associations between acute kidney injury and clinical characteristics, in-hospital treatments, outcomes, and resource utilization were assessed using multivariable analyses. A total of 3346 hospital admissions were included in the analysis. Acute kidney injury occurred in 1206 (36%) admissions, of which 49 (1.5%) required dialysis. The risk factors for acute kidney injury included age 20–39 years, African American race, obesity, chronic kidney disease, congestive heart failure, and rhabdomyolysis, whereas age <20 or ≥60 years were associated with lower risk of acute kidney injury. The need for mechanical ventilation and blood transfusion was higher when acute kidney injury occurred. Acute kidney injury was associated with electrolyte and acid-base derangements, sepsis, acute myocardial infarction, ventricular arrhythmia or cardiac arrest, respiratory, circulatory, liver, neurological, hematological failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher in acute kidney injury patients. Approximately one third of heat stroke patients developed acute kidney injury during hospitalization. Acute kidney injury was associated with several complications, and higher mortality and resource utilization.