Low Incidence of Death and Renal Failure in United States Military Service Members Hospitalized with Exertional Heat Stroke: A Retrospective Cohort Study

Donham, Benjamin; Frankfurt, Sheila; Cartier, Rudolph A; O'Hara, Sean M; Sieg, Vanessa

doi:10.1093/milmed/usz214

Cited by 20 publications

(11 citation statements)

References 17 publications

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“…The titles and abstracts were screened, and 1502 articles excluded, leaving 154 articles for full-text review. Data in Table S2 depict that 41 articles were included in the review [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ], comprising 29 descriptive and cross-sectional studies [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 …”

Section: Resultsmentioning

confidence: 99%

“…In this study, the prevalence of severe heat illness was 0.3% and the prevalence of mild heat illness was 1.1% [ 50 ]. Due to insufficient data, the rates of EHI in 14 studies could not be calculated using the number of participants as denominators [ 22 , 36 , 38 , 40 , 41 , 42 , 46 , 47 , 52 , 54 , 58 , 59 , 60 , 61 ].…”

Section: Resultsmentioning

confidence: 99%

“…The clinical features of EHI (precisely, EHS) were identified from 10 studies [ 22 , 38 , 40 , 42 , 43 , 46 , 47 , 52 , 54 , 61 ]. The most common clinical presentations were loss of consciousness (54%), absence of sweating (47%), confusion (45%) and dehydration (44%).…”

Section: Resultsmentioning

confidence: 99%

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Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies

Alele

Malau‐Aduli

et al. 2020

IJERPH

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Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk factors influencing EHI were gender, physical fitness, obesity, previous history of heat illness, and motivation, while the extrinsic factors included hot environmental conditions and service unit. Evidence suggests that loss of consciousness, absence of sweating and confusion were the common clinical features of exertional heat stroke (EHS). The mean core temperature ranged from 40 to 41.6 °C, while elevated levels of creatine phosphokinase, liver enzymes, and creatinine were common biochemical markers of EHS. The findings of the review suggest a variation in the incidence of EHI among military populations possibly due to the varying definitions used. Although some risk factors of EHI were identified, more analytical studies are needed to investigate the association between EHI and other important factors such as acclimatisation and occlusive clothing.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies

Alele

Malau‐Aduli

et al. 2020

IJERPH

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“…Exertional heat stroke commonly occurs among young healthy persons who are vigorously active in environments with high ambient temperatures and humidity levels [6,7]. By contrast, classic heat stroke is frequently found among older patients with underlying medical conditions that impair their ability to dissipate heat and intervene in their access to hydration [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States

Chewcharat

Petnak

Cheungpasitporn

et al. 2020

JCM

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Background: This study aimed to assess the risk factors and impact of acute myocardial infarction on in-hospital treatments, complications, outcomes, and resource utilization in hospitalized patients for heat stroke in the United States. Methods: Hospitalized patients with a principal diagnosis of heat stroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Acute myocardial infarction was identified using the hospital International Classification of Diseases, Ninth Revision (ICD-9), diagnosis of 410.xx. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without acute myocardial infarction were compared. Results: A total of 3372 heat stroke patients were included in the analysis. Of these, acute myocardial infarction occurred in 225 (7%) admissions. Acute myocardial infarction occurred more commonly in obese female patients with a history of chronic kidney disease, but less often in male patients aged <20 years with a history of hypothyroidism. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with acute myocardial infarction. Acute myocardial infarction was associated with rhabdomyolysis, metabolic acidosis, sepsis, gastrointestinal bleeding, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, circulatory failure, liver failure, neurological failure, and hematologic failure. Patients with acute myocardial infarction had 5.2-times greater odds of in-hospital mortality than those without myocardial infarction. The length of hospital stay and hospitalization cost were also higher when an acute myocardial infarction occurred while hospitalized. Conclusion: Acute myocardial infarction was associated with worse outcomes and higher economic burden among patients hospitalized for heat stroke. Obesity and chronic kidney disease were associated with increased risk of acute myocardial infarction, while young male patients and hypothyroidism were associated with decreased risk.

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“…As such, this heat stress hypothesis contends that physical work in the heat causes injury to the kidneys. This injury can be lowgrade, as assessed with kidney injury markers (8,10), or overt acute kidney injury (AKI), which is a clinical diagnosis that typically occurs subsequent to exertional heat stroke in the setting of occupational heat exposure (11) and is assessed via specific criteria for increased serum creatinine and/or decreased urine output (12,13). CKDnt may then develop following repeated exposures to low-grade kidney injury and/or a singular bout of clinically diagnosed AKI brought about by physical work in the heat (3,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States

Chapman

Hess

Lucas

et al. 2021

American Journal of Physiology-Regulatory, Integrative and Comp

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Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of non-traditional origin (CKDnt) is occurring among manual laborers, while potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative mini review is to identify occupations that may place United States workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in United States workers supports the need for future investigations to understand this risk of CKDnt.

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Low Incidence of Death and Renal Failure in United States Military Service Members Hospitalized with Exertional Heat Stroke: A Retrospective Cohort Study

Cited by 20 publications

References 17 publications

Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies

Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies

Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States

Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States

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