Circulatory Failure among Hospitalizations for Heatstroke in the United States

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.

Circulatory Shock among Hospitalized Patients for Salicylate Intoxication

“…Salicylate intoxication can increase body temperature by uncoupling of oxidative phosphorylation in the mitochondria. It can be hypothesized that obese patients tend to have higher heat production and fluid loss from diaphoresis, translating to increased risk for circulatory shock [ 6 ]. In addition, elderly and obese patients have been observed to have lower salicylate clearances [ 13 ].…”

“…Circulatory shock has been associated with increased mortality in several medication conditions [ 6 , 7 ]. Data has been limited, however, on its impact on hospital outcomes and resource utilization in patients with salicylate intoxication.…”

“…Finally, we demonstrated that circulatory shock was associated with higher resource utilization, longer length of stay, and increased hospitalization costs compared to salicylate intoxication in patients without circulatory shock. Although the impact of circulatory shock on hospital resource utilization has never been previously described in salicylate intoxication patients, circulatory shock has been previously reported to increase hospital resource utilization in other conditions, such as heat stroke [ 6 ].…”

“…We also assessed independent predictors for in-hospital mortality. Even though circulatory shock is associated with poor outcomes in several diseases [ 6 , 7 ], risk factors and impact of circulatory shock on outcomes and resource use in salicylate intoxication have not been well investigated. Therefore, we conducted this study to evaluate risk factors for circulatory shock and its impact on outcomes in hospitalized patients with salicylate intoxication in the United States.…”

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

“…Heat stroke is categorized as either nonexertional and exertional. Nonexertional heat stroke, also called classic heat stroke, is common among elderly patients exposed to prolonged hot and humid environments, while exertional heat stroke frequently occurs in active young adults who undergo extreme exertion at high temperatures [2][3][4].…”