Classic heat stroke in a desert climate: A systematic review of 2632 cases

Abstract

Background Although classic heat stroke (HS) is one of the most ancient conditions known to humans, the description of its early clinical manifestations, natural course, and complications remains uncertain. Objectives A systematic review of the demographics, clinical characteristics, biomarkers, therapy, and outcomes of HS during the Muslim (Hajj) pilgrimage in the desert climate of Mecca, Saudi Arabia. Methods We searched the MEDLINE, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases from inception to April 2022. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics. Results Forty‐four studies, including 2632 patients with HS, met the inclusion criteria. Overweight or obesity, diabetes, and cardiovascular disease were prevalent among cases of HS. Evidence suggests that extreme hyperthermia (pooled mean = 42.0°C [95% confidence interval (CI): 41.9, 42.1], range 40–44.8°C) with hot and dry skin (>99% of cases) and severe loss of consciousness (mean Glasgow Coma Scale <8 in 53.8% of cases) were the dominant clinical characteristics of classic HS. Hypotension, tachypnea, vomiting, diarrhea, and biochemical biomarkers indicating mild‐to‐moderate rhabdomyolysis, acute kidney, liver, heart injury, and coagulopathy were frequent at the onset. Concomitantly, stress hormones (cortisol and catecholamines) and biomarkers of systemic inflammation and coagulation activation were increased. HS was fatal in 1 in 18 cases (pooled case fatality rate = 5.6% [95%CI: 4.6, 6.5]). Conclusions The findings of this review suggest that HS induces an early multiorgan injury that can progress rapidly to organ failure, culminating in death, if it is not recognized and treated promptly.

Escalating climate-related health risks for Hajj pilgrims to Mecca

“…This is practically true in the periods when Hajj has just left, or about to enter, a hot cycle, where temperatures remain high. The overall CFR for HS was 5%, aligning closely with a recent systematic review of HS among Hajj pilgrims, 26 but lower than in other settings. 27 This difference may be partially attributed to quick access to healthcare during Hajj.…”

Escalating climate-related health risks for Hajj pilgrims to Mecca

“…This is practically true in the periods when Hajj has just left, or about to enter, a hot cycle, where temperatures remain high. The overall CFR for HS was 5%, aligning closely with a recent systematic review of HS among Hajj pilgrims, 26 but lower than in other settings. 27 This difference may be partially attributed to quick access to healthcare during Hajj.…”

A nomogram based on InLDH and InNLR for predicting disseminated intravascular coagulation in patients with heat stroke

“…DIC is an early common complication in HS and occurs in approximately 11.2%-30% of patients with HS. 5,11,12 Our study found a similar result (22.4%) for the incidence of DIC. Zeng et al 8 found that the mortality of patients with DIC was about 47.4%, which was significantly higher than that of patients without DIC.…”

“…DIC is an early common complication in HS and occurs in approximately 11.2%–30% of patients with HS. 5,11,12 Our study found a similar result (22.4%) for the incidence of DIC. Zeng et al.…”

The Heat Illness Avatar: An Open, Interactive Resource for Characterisation of Heat-Related Illness

“…Nervous system -Neurological manifestations were the most prominent feature of HRI, with altered consciousness (32%, RR = 0.49, 95% CI [0. 35 , highlighting the profound impact of HRI on the cardiovascular system. Is it Urinary system -The most common clinical feature from the urinary system was acute renal injury, which was observed in 29% of HRI cases (RR = 0.94, 95% CI [0.65, 1.36]).…”

“…The key words and search terms were adapted from Yezli and colleagues 35 and refined through consultation with a university research librarian. An initial search strategy was developed for Medline (Pubmed), comprising of the following keywords: ("Heat Stress Disorders" [Mesh term]) OR ("exertional heat" OR "heat syncope" OR "heat exhaustion" OR "heat stroke" OR "heat illness*" OR "heat injur*") AND ("case report" OR "case series" OR "case reports" OR "case*" OR "incident report*" OR "case study" OR "case studies").…”

Escalating climate-related health risks for Hajj pilgrims to Mecca

“…This is practically true in the periods when Hajj has just left, or about to enter, a hot cycle, where temperatures remain high. The overall CFR for HS was 5%, aligning closely with a recent systematic review of HS among Hajj pilgrims, 26 but lower than in other settings. 27 This difference may be partially attributed to quick access to healthcare during Hajj.…”

A nomogram based on InLDH and InNLR for predicting disseminated intravascular coagulation in patients with heat stroke

“…DIC is an early common complication in HS and occurs in approximately 11.2%-30% of patients with HS. 5,11,12 Our study found a similar result (22.4%) for the incidence of DIC. Zeng et al 8 found that the mortality of patients with DIC was about 47.4%, which was significantly higher than that of patients without DIC.…”

“…DIC is an early common complication in HS and occurs in approximately 11.2%–30% of patients with HS. 5,11,12 Our study found a similar result (22.4%) for the incidence of DIC. Zeng et al.…”

The Heat Illness Avatar: An Open, Interactive Resource for Characterisation of Heat-Related Illness

“…Nervous system -Neurological manifestations were the most prominent feature of HRI, with altered consciousness (32%, RR = 0.49, 95% CI [0. 35 , highlighting the profound impact of HRI on the cardiovascular system. Is it Urinary system -The most common clinical feature from the urinary system was acute renal injury, which was observed in 29% of HRI cases (RR = 0.94, 95% CI [0.65, 1.36]).…”

“…The key words and search terms were adapted from Yezli and colleagues 35 and refined through consultation with a university research librarian. An initial search strategy was developed for Medline (Pubmed), comprising of the following keywords: ("Heat Stress Disorders" [Mesh term]) OR ("exertional heat" OR "heat syncope" OR "heat exhaustion" OR "heat stroke" OR "heat illness*" OR "heat injur*") AND ("case report" OR "case series" OR "case reports" OR "case*" OR "incident report*" OR "case study" OR "case studies").…”

Escalating climate-related health risks for Hajj pilgrims to Mecca

“…This is practically true in the periods when Hajj has just left, or about to enter, a hot cycle, where temperatures remain high. The overall CFR for HS was 5%, aligning closely with a recent systematic review of HS among Hajj pilgrims, 26 but lower than in other settings. 27 This difference may be partially attributed to quick access to healthcare during Hajj.…”

A nomogram based on InLDH and InNLR for predicting disseminated intravascular coagulation in patients with heat stroke

“…DIC is an early common complication in HS and occurs in approximately 11.2%-30% of patients with HS. 5,11,12 Our study found a similar result (22.4%) for the incidence of DIC. Zeng et al 8 found that the mortality of patients with DIC was about 47.4%, which was significantly higher than that of patients without DIC.…”

“…DIC is an early common complication in HS and occurs in approximately 11.2%–30% of patients with HS. 5,11,12 Our study found a similar result (22.4%) for the incidence of DIC. Zeng et al.…”

The Heat Illness Avatar: An Open, Interactive Resource for Characterisation of Heat-Related Illness

“…Nervous system -Neurological manifestations were the most prominent feature of HRI, with altered consciousness (32%, RR = 0.49, 95% CI [0. 35 , highlighting the profound impact of HRI on the cardiovascular system. Is it Urinary system -The most common clinical feature from the urinary system was acute renal injury, which was observed in 29% of HRI cases (RR = 0.94, 95% CI [0.65, 1.36]).…”

“…The key words and search terms were adapted from Yezli and colleagues 35 and refined through consultation with a university research librarian. An initial search strategy was developed for Medline (Pubmed), comprising of the following keywords: ("Heat Stress Disorders" [Mesh term]) OR ("exertional heat" OR "heat syncope" OR "heat exhaustion" OR "heat stroke" OR "heat illness*" OR "heat injur*") AND ("case report" OR "case series" OR "case reports" OR "case*" OR "incident report*" OR "case study" OR "case studies").…”