Received date: 04 Aug 2023
Revised date: 13 Dec 2023
Accepted date: 18 Dec 2023
Copyright
Background: Temperature control plays a pivotal role in patients with heat stroke (HS), but little work has been done sufficiently on the use of temperature control to reflect disease progression. Here, we defined and analyzed the concrete role of controlling time for core temperature to physiological level (CTTP), in order to explore a potential index to guide the treatment of HS.
Method: This is a retrospective cohort study. From three hospitals located in Sichuan province, China, we collected a total of 179 HS cases with clinical diagnosis and treatment records. We defined CTTP as the time interval of HS onset to stabilization of core temperature (rectal temperature) below 37.7°C and analyzed the correlation between CTTP and inpatient death of HS patients.
Results: Of all the cases, 64.80% were male and 53.07% were exertional heat stroke (EHS). The median (IQR) age was 59 (23.5–73) years old, and the median (IQR) onset temperature was 42 (40.4–42)°C. Multivariable analysis demonstrated significantly high inpatient death in the highest CTTP tertile (>18 h) (hazard ratio: 18.75; 99% confidence interval: 4.06–86.59; p = .0002). In addition, compared with patients in lowest CTTP tertile, patients in highest CTTP tertile were at significantly higher risk of organ damage: 3.48-fold for respiratory failure (95% CI: 1.41–8.59, p = .0069); 3.18-fold for shock (95% CI: 1.37–7.39, p = .0071); 4.09-fold for rhabdomyolysis (95% CI: 1.73–9.64, p = .0013); 4.64-fold for renal damage (95% CI: 2.12–10.14, p = .0001).
Conclusion: Long of CTTP predicts inpatient death of HS patients with a CTTP tertile >18 h associated with the highest rate of inpatient death.
Key words： CTTP; heat stroke; inpatient death; organ damage
Jian Feng , Mingyang Tang , Meiting Gong , Fuxiang Li , Yunming Li , Bo Huang , Fan Feng , Xiong Wang , Haifeng Pei . A novel indicator for temperature control in heat stroke treatment[J]. Precision Medical Sciences, 2024 , 13(1) : 21 -28 . DOI: 10.1002/prm2.12123
| 1 |
Gaudio FG, Grissom CK. Cooling methods in heat stroke. J Emerg Med. 2016;50(4):607-616.
|
| 2 |
Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25):1978-1988.
|
| 3 |
Glaser J, Lemery J, Rajagopalan B, et al. Climate change and the emergent epidemic of CKD from heat stress in rural communities: the case for heat stress nephropathy. Clin J Am Soc Nephrol. 2016;11(8):1472-1483.
|
| 4 |
Otani S, Funaki IS, Masumoto T, et al. The effect of minimum and maximum air temperatures in the summer on heat stroke in Japan: a time-stratified case-crossover study[J]. Int J Environ Res Public Health. 2021;18(4):1632.
|
| 5 |
Han J, Liu S, Zhang J, et al. The impact of temperature extremes on mortality: a time-series study in Jinan, China. BMJ Open. 2017;7(4):e014741.
|
| 6 |
Chen K, Horton RM, Bader DA, et al. Impact of climate change on heat-related mortality in Jiangsu Province, China. Environ Pollut. 2017;224:317-325.
|
| 7 |
Li Y, Li C, Luo S, et al. Impacts of extremely high temperature and heatwave on heatstroke in Chongqing, China. Environ Sci Pollut Res Int. 2017;24(9):8534-8540.
|
| 8 |
Liu S-Y, Song J-C, Mao H-D, et al. Expert consensus on the diagnosis and treatment of heat stroke in China. Mil Med Res. 2020;7(1):1.
|
| 9 |
Demartini JK, Casa DJ, Stearns R, et al. Effectiveness of cold water immersion in the treatment of exertional heat stroke at the Falmouth road race. Med Sci Sports Exerc. 2015;47(2):240-245.
|
| 10 |
Hifumi T, Kondo Y, Shimizu K, Miyake Y. Heat stroke. J Intensive Care. 2018;6:30.
|
| 11 |
Heled Y, Rav-Acha M, Shani Y, Epstein Y, Moran DS. The "golden hour" for heatstroke treatment. Mil Med. 2004;169(3):184-186.
|
| 12 |
Casa DJ, Armstrong LE, Kenny GP, O'Connor FG, Huggins RA. Exertional heat stroke: new concepts regarding cause and care. Curr Sports Med Rep. 2012;11(3):115-123.
|
| 13 |
Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556-572.
|
| 14 |
Vicario SJ, Okabajue R, Haltom T. Rapid cooling in classic heatstroke: effect on mortality rates. Am J Emerg Med. 1986;4(5):394-398.
|
| 15 |
Jung YS, Kim HH, Yang HW, Choi S. Targeted temperature management in patients with severe heatstroke: three case reports and treatment recommendations. Medicine (Baltimore). 2020;99(45):e23159.
|
| 16 |
Ito C, Takahashi I, Kasuya M, et al. Safety and efficacy of cold-water immersion in the treatment of older patients with heat stroke: a case series. Acute Med Surg. 2021;8(1):e635.
|
| 17 |
Miller KC, Hughes LE, Long BC, Adams WM, Casa DJ. Validity of Core temperature measurements at 3 rectal depths during rest, exercise, cold-water immersion, and recovery. J Athl Train. 2017;52(4):332-338.
|
| 18 |
Epstein Y, Yanovich R. Heatstroke. N Engl J Med. 2019;380(25):2449-2459.
|
| 19 |
Shapiro Y, Seidman DS. Field and clinical observations of exertional heat stroke patients. Med Sci Sports Exerc. 1990;22(1):6-14.
|
| 20 |
Thongprayoon C, Qureshi F, Petnak T, et al. Impact of acute kidney injury on outcomes of hospitalizations for heat stroke in the United States. Diseases. 2020;8(3):28.
|
| 21 |
Varghese GM, John G, Thomas K, Abraham OC, Mathai D. Predictors of multi-organ dysfunction in heatstroke. Emerg Med J. 2005;22(3):185-187.
|
| 22 |
Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment[J]. JAMA. 2018;319(7):698-710.
|
| 23 |
Pease S, Bouadma L, Kermarrec N, Schortgen F, Régnier B, Wolff M. Early organ dysfunction course, cooling time and outcome in classic heatstroke. Intensive Care Med. 2009;35(8):1454-1458.
|
| 24 |
Marchand M, Gin K. The cardiovascular system in heat stroke. CJC Open. 2022;4(2):158-163.
|
| 25 |
Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B. Prognostic factors in heat wave related deaths: a meta-analysis[J]. Arch Intern Med. 2007;167(20):2170-2176.
|
| 26 |
Sprung CL. Hemodynamic alterations of heat stroke in the elderly. Chest. 1979;75(3):362-366.
|
| 27 |
Laitano O, Oki K, Leon LR. The role of skeletal muscles in exertional heat stroke pathophysiology. Int J Sports Med. 2021;42(8):673-681.
|
| 28 |
Abdelmoety DA, El-Bakri NK, Almowalld WO, et al. Characteristics of heat illness during hajj: a cross-sectional study. Biomed Res Int. 2018;2018:5629474.
|
| 29 |
Fan H, Zhao Y, Zhu JH, et al. Thrombocytopenia as a predictor of severe acute kidney injury in patients with heat stroke. Ren Fail. 2015;37(5):877-881.
|
| 30 |
Argaud L, Ferry T, Le QH, et al. Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France. Arch Intern Med. 2007;167(20):2177-2183.
|
| 31 |
Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O. Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke. BMC Nephrol. 2016;17(1):55.
|
| 32 |
Sithinamsuwan P, Piyavechviratana K, Kitthaweesin T, et al. Exertional heatstroke: early recognition and outcome with aggressive combined cooling—a 12-year experience. Mil Med. 2009;174(5):496-502.
|
| 33 |
Liu SY, Wang Q, Lou YP, et al. Interpretations and comments for expert consensus on the diagnosis and treatment of heat stroke in China[J]. Mil Med Res. 2020;7(1):37.
|
/
| 〈 |
|
〉 |