Association Between Early Stage-Related Factors and Mortality in Patients with Exertional Heat Stroke: A Retrospective Study of 214 Cases

Abstract

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.

Patients with heat-related illness admitted to an intensive care unit in Hong Kong: A single-centre retrospective study (2009–2020)

“…We found lower mortality (7.9%) of HRI in our study compared with that of 14.5% observed by Liu et al 7 In the paper from China, the documented admission median peak body temperature was 42°C, which was 1.7°C higher than our patients. Another possibility might be related to the severity of the patients; only the more severe cases were admitted to their tertiary hospitals, while milder cases were triaged to secondary medical centres.…”

“…Exertional heat stroke represents the most severe entity among heat disorders 4–6 . Mortality of heat stroke ranged between 10% and 50% in the previous study 7 . While potentially fatal, it is preventable and salvageable.…”

“…[4][5][6] Mortality of heat stroke ranged between 10% and 50% in the previous study. 7 While potentially fatal, it is preventable and salvageable. Patients suffering from the severe extreme of HRI often require advanced life supports in intensive care unit (ICU).…”

A case report of near-missed heat stroke

“…It is possible that both general supportive care and individual factors play important roles in the prognosis of severe heat-related illnesses. [ 10 ] It is likely that timely removal of this patient from the environment and management of his delirious state with sedative drugs stopped further exertion, thereby reducing further heat production. In addition, the Emergency Department was air conditioned.…”

Association between cooling temperature and outcomes of patients with heat stroke

“…However, these studies focused on the on-site emergency treatments for exertional HS (EHS). Regarding hospitalised patients, Liu et al [ 16 ] found that, if BT did not effectively cool (< 38.0 °C) within 4.88 h, patients had a higher risk of in-hospital death. In fact, Yokobori et al [ 17 ] considered a temperature of 37 °C within the first 24 h as optimal values, arguing that these parameters significantly reduce the Sequential Organ Failure Assessment (SOFA) scores.…”