Heat stroke (HS) is a fatal disease caused by thermal damage in the body, and it has a very high mortality rate. In 2015, the People's Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China, Expert consensus on standardized diagnosis and treatment for heat stroke. With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years, the 2015 consensus no longer meet the requirements for HS prevention and treatment. It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage, is more practical and is more in line with China's national conditions. This new expert consensus includes new concept of HS, recommendations for laboratory tests and auxiliary examinations, new understanding of diagnosis and differential diagnosis, On-site emergency treatment and In-hospital treatment, translocation of HS patients and prevention of HS.

Objective The purpose of this study is to evaluate the factors involved in the early stage of exertional heat stroke (EHS) that are associated with mortality. Methods In this retrospective, case-control study, patients from 11 tertiary medical centers in China were enrolled from January 1, 2012, to December 31, 2019. Demographic information, underlying diseases, ambient temperature, and relative humidity, clinical manifestations, initial body temperature, time from onset to diagnosis of EHS (including suspected), and the duration of body temperature > 38°C of all enrolled patients were recorded. The occurrence of organ dysfunction within 72 h was evaluated, and in-hospital deaths were recorded. The patients were subsequently divided into a survival group and a non-survival group. The “case” refers to patients in the non-survival group, while the “control” refers to patients without death. Results Of the 214 hospitalized patients with EHS, 183 survived and 31 died, and the overall mortality was 14.49% (31/214). A binary logistic regression showed that only the duration of body temperature > 38°C (OR 1.80, 95% CI 1.34–2.42) and the number of organs damaged within 72 h of onset (OR 6.54, 95% CI 2.31–18.56) were statistically significant in terms of risk of death in hospital (p < 0.05). A goodness of fit test produced a p-value of 0.76. According to receiver operating characteristic curve (ROC) analysis, the areas under the curve (AUC) were 0.989 (95% CI 0.978–1.000; p < 0.05) and 0.936 (95% CI 0.896–0.976; p < 0.05). Conclusion Of the various factors involved in the early stage of the disease, the duration of high body temperature and the number of organs damaged within 72 h of onset were independent risk factors and predictors associated with death.

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Background: Exertional heat stroke (EHS) is a life-threatening illness that can lead to multiple organ damage in the early stage. Objective: This study aimed to investigate the relationship between 24-hour indicators and mortality in patients with EHS. Methods: The records of EHS patients hospitalized were collected and divided into the death group and the survival group. We then analyzed the demographic characteristics and APACHE II scores and laboratory results of the participants in the blood within the first 24 h after hospitalization, and assessed whether these candidate indicators differed between the death group and the survival group. Cox regression analysis of the survival data was performed to explore the relationship between early indicators and prognosis. Results: The levels of plasma PT, APTT, TT, and INR were significantly higher in the death group than in the survival group. The blood PLT count and the levels of PTA and Fb were significantly lower in the death group than in the survival group, while the levels of BU, SCr, ALT, AST, TBil, and DBil were significantly higher in the death group than in the survival group. Furthermore, the levels of Mb, LDH, TNI, and NT-proBNP were significantly higher in the death group than in the survival group, while there was no significant difference in CK levels between the two groups. Conclusion: Patients with EHS often had multiple organ injuries in the early stage (within 24 h), while those cases in the death group were more severe.

Introduction/Aims: Exertional rhabdomyolysis (ER) often occurs during prolonged intense exercise in hot environments, posing a threat to the health of military personnel. In this study we aimed to investigate possible risk factors for ER and provide further empirical data for prevention and clinical treatment strategies.Methods: A retrospective investigation of 116 concurrent ER cases was conducted.Conditional logistic regression analyses were performed to assess the association between each potential risk (or protective) factor and ER. The clinical characteristics of the 71 hospitalized patients were analyzed descriptively.Results: After screening, the following variables significantly increased the risk of ER: shorter length of service (recruits; odds ratios [OR], 7.49; 95% confidence interval [CI], 2.58-21.75); higher body mass index (BMI; OR, 1.14, 95% CI, 1.03-1.26); lack of physical exercise in the last half year (less than once per month; OR, 3.20; 95% CI, 1.08-9.44); and previous heat injury (OR, 2.94; 95% CI, 1.26-6.89). Frequent fruit consumption (OR, 0.57; 95% CI, 0.33-0.99), active hydration habit (OR, 0.37; 95% CI, 0.20-0.67), water replenishment of more than 2 L on the training day (OR, 0.15; 95% CI, 0.05-0.45), and water replenishment of at least 500 mL within 1 hour before training (OR, 0.33; 95% CI, 0.12-0.88) significantly decreased the risk of ER. Of the 71 hospitalized patients, 41 (57.7%) were diagnosed with hypokalemia on admission.Discussion: In military training, emphasis should be placed on incremental adaptation training before more intense training, and close attention should be given to overweight and previously sedentary recruits. Fluid replenishment before exercise, increased fruit intake, and proper potassium supplementation may help prevent ER.

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BackgroundExertional rhabdomyolysis (ER) often occurs during prolonged intense exercise in hot environments, posing a threat to the health and safety of military personnel.ObjectiveTo investigate possible risk factors of ER and provide further empirical data for prevention and clinical treatment strategies for ER.MethodsIn this study, a systematic retrospective investigation on 116 concurrent cases of ER was conducted. Demographic, clinical, and exercise-related data were collected from both ER cases and controls which were allotted by 1:3 proportion. Conditional logistic regression analyses were performed to calculate the significance of the association between each potential risk (or protective) factors and ER.ResultsThe adjusted ER prediction model finally included the following variables that significantly increased (or decreased) the risk of acquiring ER: age (odds ratios [OR] 0.59, 95% confidence interval [CI]0.45–0.79), body mass index (BMI, OR 1.11, 95%CI 1.01–1.24), dark-colored urine after training (OR 2.98, 95%CI 1.58–5.64), frequent fruit consumption (OR 0.54, 95%CI 0.29–0.98), active hydrating habit (OR 0.31, 95%CI 1.58–5.64), water replenishment ≥ 2L on the training day (OR 0.18, 95%CI 0.06–0.54), water replenishment ≥ 500 ml within 1 hour before training (OR 0.32, 95%CI 0.11–0.90), lack of physical exercise in the last half-year (OR 3.23, 95%CI 1.34–7.80).ConclusionsIn military training, emphasis should be placed on incremental adaptation training prior to more intense training, and close attention should be paid to overweight and previously sedentary recruits. Fluid replenishment before exercise, increased fruit intake, and proper potassium supplementation may help to prevent ER.