Clinical characteristics and risk factors of male exertional heatstroke in patients with myocardial injury: an over 10-year retrospective cohort study

Abstract

Background: Heatstrokes are a serious threat to human health, particularly the cardiovascular system. Understanding the clinical features and risk factors related to death in patients with myocardial injury (MI) complicated by heat stroke is crucial. Method: This study included the baseline data of all patients with severe heatstroke between October 2008 and May 2019. Results: Of the 162 patients enrolled, 75 (46.3%) were in the MI group and 87 (53.7%) were in the non-MI group. A significant difference was noted in 90-day survival between the two groups even after correction for Age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, Glasgow Coma Score (GCS), and activated partial thromboplastin time (before correction (p < .001; after correction, p ¼ .023). Survival analysis showed that the 90-day survival time of patients with MI was shorter than that of patients without MI (p < .001). The area under the receiver operating characteristic (ROC) curve for predicting mortality based on the SOFA score was 92.8% (95% CI 0.847-1.000, p < .001), the optimal cutoff value was 7.5, the sensitivity was 91.7%, and the specificity was 94.6%. Conclusion: Patients with heatstroke having MI had more severe clinical conditions, 90-day mortality was significantly increased, and the survival time was shortened. A high SOFA score is an independent risk factor for death in patients with heatstroke having MI, with an optimal cutoff value of 7.5, sensitivity of 91.7%, and specificity of 94.6%.

Clinical relevance of neutrophil/lymphocyte ratio combined with APACHEII for prognosis of severe heatstroke

“…Prognostic prediction of severe heatstroke using APACHEII score alone may be biased because this disease is often associated with severe coagulation abnormalities and rhabdomyolysis, which are not included in APACHEII score [ 24 ]. Also, it has been shown that there is no significant difference in blood creatinine and bilirubin between surviving and deceased individuals with severe heatstroke, amid these factors reducing the predictive efficacy [ 23 , 25 ]. Our ROC results showed that combination of NLR and APACHEII score was significantly better for predicting death of severe heatstroke patients than using the two individually.…”

A Nomogram for Predicting Patients With Severe Heatstroke

“…These two factors were retained in the prediction model. Myocardial injury is another feature of severe heatstroke, and it is known to increase the risk of death during the rapid progression of severe heatstroke (5,15). Furthermore, TNI appeared to be an analysis factor for death from severe heatstroke (hazard ratio, 1.223; 95% CI, 1.095–1.367; P < 0.0001), which was consistent with findings from prior studies (16).…”

Severe acute liver injury in patients with exertional heat stroke associated with poor short-term prognosis

“…The course of severe heat-related illnesses combined with SALI and ALF involves protein denaturation, endotoxin release, thermoregulatory disorder, SIRS, interleukin-1beta (IL-1β) and high-mobility group box 1 (HMGB-1)-induced pyroptosis, leading to massive or submassive hepatocyte necrosis, which ultimately aggravates the conditions of such patients. [20,27,28] The 10%-30% mortality rate of EHS in developing countries is still relatively high, [26,29,30] whereas its mortality rate in developed countries is less than 5%. [20,31] An Indian study has demonstrated that the mortality rate reaches 86% when heat stroke is accompanied by MODS.…”