The Relationship Between 24-Hour Indicators and Mortality in Patients with Exertional Heat Stroke

Abstract

Background: Exertional heat stroke (EHS) is a life-threatening illness that can lead to multiple organ damage in the early stage. Objective: This study aimed to investigate the relationship between 24-hour indicators and mortality in patients with EHS. Methods: The records of EHS patients hospitalized were collected and divided into the death group and the survival group. We then analyzed the demographic characteristics and APACHE II scores and laboratory results of the participants in the blood within the first 24 h after hospitalization, and assessed whether these candidate indicators differed between the death group and the survival group. Cox regression analysis of the survival data was performed to explore the relationship between early indicators and prognosis. Results: The levels of plasma PT, APTT, TT, and INR were significantly higher in the death group than in the survival group. The blood PLT count and the levels of PTA and Fb were significantly lower in the death group than in the survival group, while the levels of BU, SCr, ALT, AST, TBil, and DBil were significantly higher in the death group than in the survival group. Furthermore, the levels of Mb, LDH, TNI, and NT-proBNP were significantly higher in the death group than in the survival group, while there was no significant difference in CK levels between the two groups. Conclusion: Patients with EHS often had multiple organ injuries in the early stage (within 24 h), while those cases in the death group were more severe.

From the Thyroid to the Heart

“…A description of the characteristics of heat stroke and cardiac dysfunction published by Marchand and Gin were centered on thermoregulation and heat dissipation (Figure 1 in (283)). Other authors have found a relation between biomarkers and mortality after exertional heat stress where fatal cases had higher levels of NT-proBNP (284). A current view on heatstroke which does not consider the role of CoQ 10 was published by Bouchama (285).…”

N-terminal pro-brain natriuretic peptide – a significant biomarker of disease development and adverse prognosis in patients with exertional heat stroke

“…Rhabdomyolysis caused by EHS often results from mechanical and metabolic injury to the striated muscle fibers accompanied with the release of muscle contents into the circulation [ 3 ]. Liu et al [ 4 ] also found that NT-proBNP levels were significantly higher in dead group than those in survival group in the EHS related study. There are scarce literature assessing biochemical biomarkers including myocardial enzymes and NT-proBNP in patients with EHS all around the world.…”

“…It was found that physical exercise could affect NT-proBNP levels, but no severe myocardial injury was found in healthy individuals. After physical exercise, NT-proBNP elevation is not caused by myocardial injury but has cytoprotective effects, whereas the release of myocardial enzymes should be considered irreversible injury or myocardial infarction [ 4 ]. The present study illustrated that NT-proBNP rather than myocardial enzymes was significantly associated with adverse prognosis in patients with EHS, suggesting that NT-proBNP is superior to myocardial enzymes as an important biomarker of EHS to evaluate the occurrence and prognosis of EHS [ 5 ].…”

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

“…Currently, there are no validated scoring tools for predicting severe heatstroke. In spite of this, the acute physiology and chronic health evaluation (APACHEII) score is being used to predict severe heatstroke [ 4 ]. However, prediction of severe heatstroke with APACHEII is controversial, amid the scoring being cumbersome and requiring multiple blood parameters which are not readily available at emergency department [ 5 ].…”