Clinical Characteristics and Risk Factors Associated With Acute Kidney Injury Inpatient With Exertional Heatstroke: An Over 10-Year Intensive Care Survey

Abstract

Background: Exertional heat stroke (EHS) is a life-threatening injury that can lead to acute kidney injury (AKI). The clinical characteristics of and risk factors for EHS complicated with AKI have been poorly documented.Methods: A retrospective study with EHS admitted to the intensive care unit (ICU) from January 2008 to June 2019 was performed. Data including baseline clinical information at admission, main organ dysfunction, 90-day mortality and total cost of hospitalization were collected.Results: A total of 187 patients were finally included, of which 82 (43.9%) had AKI. AKI patients had more severe organ injury and higher total hospitalization costs than non-AKI patients. Multivariate logistic analysis showed that lymphocyte, neutrophil, D-dimer and myoglobin (MB) ≥ 1,000 ng/ml were independent risk factors for AKI caused by EHS. In addition, SOFA score [hazard ratio (HR) 4.1, 95% confidence interval (95% CI) 1.6–10.8, P = 0.004] and GCS score (HR 3.2, 95% CI 1.2–8.4 P = 0.017) were the risk factor for 90-day mortality in patients with EHS complicated with AKI, with an area under the curve (AUC) of 0.920 (95% CI 0.842–0.998, P < 0.001) and 0.851 (95% CI 0.739–0.962, P < 0.001), respectively. Survival analysis showed that the 90-day mortality in AKI patients was significantly high (P < 0.0001) and the mortality rate of patients with AKI stage 2 was the highest than other stages.Conclusions: EHS complicated with AKI is associated with higher hospitalization costs and poorly clinical outcomes. MB ≥1,000 ng/ml, Inflammation, coagulation were associated with the occurrence and development of AKI. Early treatment strategies based reducing the SOFA and GCS score may be pivotal for improving the prognosis of EHS.

Biomarkers of heatstroke‐induced organ injury and repair

“…Indeed, patients diagnosed with heatstroke often suffer from acute kidney injury (e.g., Gauss and Meyer, 1917; Kew et al., 1967; Schrier et al., 1970), characterized by elevations in serum creatinine, which is indicative of reductions in glomerular filtration rate, measured as part of the basic clinical bloodwork (Ward et al., 2020). A recent analysis of 187 EHS cases in southern China identified that ∼44% of patients developed acute kidney injury and that ∼27% of the patients with acute kidney injury died within 90 days (Wu et al., 2021). Thus, the management of acute kidney injury following the diagnosis of heatstroke is an essential consideration.…”

“…of the patients with acute kidney injury died within 90 days (Wu et al, 2021). Thus, the management of acute kidney injury following the diagnosis of heatstroke is an essential consideration.…”

“…These findings corroborate animal literature demonstrating widespread damage across numerous organ systems following CHS (Leon et al., 2006b; Roberts et al., 2008) and EHS (King et al., 2015). Moreover, observational evidence indicates that a single episode of heatstroke could have deleterious long‐term all‐cause mortality (Wallace et al., 2007), neurological (Argaud et al., 2007; Dematte et al., 1998; Yang et al., 2017), cardiovascular (Wallace et al., 2007; Wang et al., 2019) and renal (Wang et al., 2019; Wu et al., 2021) complications with a continuous risk of death (Bouchama et al., 2022). These observations have raised the need to develop tools that aid in detecting tissue and organ injury, monitoring recovery (or repair failure), and predicting long‐term complications following heatstroke (Figure 1).…”

Sequential organ failure assessment score as a predictor of the outcomes of patients hospitalized for classical or exertional heatstroke

“…Some reports have suggested that advanced age, disturbed consciousness, elevated serum creatinine (Cre) and total bilirubin (T-bil) levels, and coagulation disorder are risk factors for death 2 , 3 . In reports that focused on exertional heatstroke, acute kidney injury 4 and myocardial injury 5 were identified as risk factors. Other groups have also developed a scoring system (exertional heat stroke score [EHSS]) for classifying the severity of exertional heatstroke 6 , 7 .…”

Sequential Organ Failure Assessment Score for Prediction of Mortality of Patients With Rhabdomyolysis Following Exertional Heatstroke: A Longitudinal Cohort Study in Southern China

“…Some studies have also shown that RM caused by heatstroke may be an important factor in initiating sepsis (2)(3)(4)(5)(6) and will further cause the disturbance of blood coagulation, which can easily lead to the occurrence of DIC (7) and AKI (8,9). Research showed that the Sequential Organ Failure Assessment (SOFA) score was an independent risk factor affecting the survival of patients (10); therefore, treatments based on reducing the SOFA score may be pivotal for reducing the mortality of EHS complicated with AKI (11). However, so far there are few clinical studies on the clinical characteristics and prognosis of EHS complicated with RM, and there is no scoring system that can predict prognosis in patients with RM with EHS.…”