Outcome and risk factors associated with extent of central nervous system injury due to exertional heat stroke

Abstract

To explore the relationship between the extent of central nervous system (CNS) injury and patient outcomes meanwhile research the potential risk factors associated with neurologic sequelae. In this retrospective cohort study, we analyzed data from 117 consecutive patients (86 survivors, 31 nonsurvivors) with exertional heat stroke (EHS) who had been admitted to intensive care unit (ICU) at 48 Chinese hospitals between April 2003 and July 2015. Extent of CNS injury was dichotomized according to Glasgow coma scale (GCS) score (severe 3–8, not severe 9–15). We then assessed differences in hospital mortality based on the extent of CNS injury by comparing 90-day survival time between the patient groups. Exploring the risk factors of neurologic sequelae. The primary outcomewas the 90-day survival ratewhich differed between the 2 groups (P = .023). The incidence of neurologic sequelae was 24.4%. For its risk factors, duration of recurrent hyperthermia (OR = 1.73, 95% CI: 1.20–2.49, P = .003), duration of CNS injury (OR = 1.39, 95% CI: 1.04–1.85, P = .025), and low GCS in the first 24 hours after admission (OR = 2.39, 95% CI: 1.11–5.15, P = .025) were selected by multivariable logistic regression. Cooling effect was eliminated as a factor (OR = 2641.27, 95% CI 0.40–1.73_107, P = .079). Significant differences in 90-day survival ratewere observed based on the extent of CNS injury in patients with EHS, and incidence was 24.4% for neurologic sequelae. Duration of recurrent hyperthermia, duration of CNS injury, and low GCS score in the first 24 hours following admission may be independent risk factors of neurologic sequelae. Cooling effect should be validated in the further studies.

Mesenchymal Stem Cells Provide Neuroprotection by Regulating Heat Stroke-Induced Brain Inflammation

“…CNS dysfunction or injury is a notable characteristic of HS. Our previous research has demonstrated that 100% of HS patients have CNS dysfunction, and the incidence of long-term neurological dysfunction reached 24.4% (35). Other research has also reported that all HS patients have CNS injury, while more than 30% of them will progress to long-term CNS dysfunction as sequela (3,5).…”

Mesenchymal Stem Cells Regulate Activation of Microglia Cells to Improve Hippocampal Nerve Damage of Heat Stroke Rats

“…CNS injury is a common complication of heat stroke. Our previous analysis of clinical data found that almost all patients will suffer central damage to different degrees, which is also the main cause of death or serious sequelae (5). The mechanism of central nerve injury in thermal radiation disease is relatively complex and may be related to two factors.…”

“…Clinically, almost all heat stroke patients suffer from varying degrees of brain injury, which is also the main cause of death or serious sequelae (5,6). In addition to high fever, ischemia, hypoxia and other factors, central nervous system (CNS) in ammatory response also plays an important role in the occurrence and development of heat-stroke-caused brain injury, and the level of such response is signi cantly correlated with nervous system injury, angioedema and neuron death (7).…”

Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report

“…Severe HS can be life-threatening, and nearly 30% of survivors present with permanent neurological sequelae [1]. The damage in the CNS due to HS is caused by a variety of factors.…”

“…Multiple organ dysfunction syndrome can occur in critically ill patients. The common complications of HS are acute respiratory distress syndrome, disseminated intravascular coagulation (DIC), shock, rhabdomyolysis, acid–base or electrolyte disorders, renal failure, cerebral edema, and liver dysfunction [1, 2]. Changes in the cerebral image of patients with HS have been rarely reported, and the mechanism of CNS damage caused by HS is not fully understood.…”