Clinical characteristics and mortality risk factors analysis of heat stroke_West China Medical Journal

Authors：

TIAN Shulin ^1,2 , WANG Qiaoyu ¹ , WEI Yuxuan ¹ , MAO Haixia ² , HU Qiongdan ³ , XIAO Wen ⁴ , TANG Li ⁵ , CHEN Junjun ⁶ , ZENG Qiang ⁶ , SHI Huiting ⁶ , HOU Li ⁶ , YANG Xin ⁷ , TANG Jian ⁸ , DENG Fuli ⁹ , TANG Huiwei ¹⁰ , LI Jing ¹¹ , AO Guangyu ¹² , WANG Yan ¹³ ,  DONG Jianhua ² ,  WU Weihua ¹

1. Department of Nephrology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Nephrology, the People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;
3. Department of Nephrology, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
4. Department of Nephrology, Deyang People’s Hospital, Deyang, Sichuan 618000, P. R. China;
5. Department of Nephrology, Zigong Third People’s Hospital, Zigong, Sichuan 643000, P. R. China;
6. ICU of Nephrology, Shuangliu District Hospital of Traditional Chinese Medicine, Chengdu, Sichuan 610000, P. R. China;
7. Department of Nephrology, Zigong First People’s Hospital, Zigong, Sichuan 643000, P. R. China;
8. Department of Nephrology, Yucheng District People’s Hospital of Ya’an, Ya’an, Sichuan 625000, P. R. China;
9. Department of Nephrology, the First People’s Hospital of Neijiang, Neijiang, Sichuan 641000, P. R. China;
10. Department of Nephrology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;
11. Department of Nephrology, the First People’s Hospital of Mianyang, Mianyang, Sichuan 621000, P. R. China;
12. Department of Nephrology, Chengdu First People’s Hospital, Chengdu, Sichuan 610000, P. R. China;
13. Department of Nephrology, the Sixth People’s Hospital of Yibin, Yibin, Sichuan 644000, P. R. China;

Corresponding author：

DONG Jianhua, Email: lsdjh502@sina.com; WU Weihua, Email: 12390369@qq.com

Keywords：

Heat stroke; acute kidney injury; clinical characteristics; risk factors

DOI：

10.7507/1002-0179.202406088

Video：

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Objective To retrospectively analyze the clinical characteristics of heat stroke (HS) and HS-acute kidney injury (AKI), analyze the risk factors leading to death in patients, and provide new ideas for the prevention and treatment of HS. Methods Patients with HS who visited 13 hospitals in Sichuan subtropical monsoon climate and HS high-incidence areas between July 2019 and September 2023 were retrospectively selected. According to whether in-hospital death or AKI occurred, the patients were divided into survival group and death group, AKI group and non-AKI group. According to serum creatinine level, patients in the AKI group were divided into AKI stage 1 group, AKI stage 2 group and AKI stage 3 group. The main clinical manifestations and important clinical data of the patients were analyzed, and the risk factors affecting the death of patients were analyzed by multivariate logistic regression. Results A total of 195 patients with HS and 115 patients with HS-AKI were included. The results of multivariate logistic regression analysis showed that AKI, abnormal coagulation function, nervous system injury, neutrophil/lymphocyte ratio, and D-dimer were independent risk factors for death (P＜0.05). The results of clinical characteristics analysis of HS-AKI showed that the mortality rate of patients with AKI stage 2 and AKI stage 3 was higher (P＜0.05). Conclusions AKI, abnormal coagulation function, nervous system injury, neutrophil/lymphocyte ratio, and D-dimer are independent risk factors for death in HS. Therefore, active treatment of patients with HS combined with AKI, abnormal coagulation function, and nervous system injury in the future will help reduce the risk of death in patients.

Citation： TIAN Shulin, WANG Qiaoyu, WEI Yuxuan, MAO Haixia, HU Qiongdan, XIAO Wen, TANG Li, CHEN Junjun, ZENG Qiang, SHI Huiting, HOU Li, YANG Xin, TANG Jian, DENG Fuli, TANG Huiwei, LI Jing, AO Guangyu, WANG Yan, DONG Jianhua, WU Weihua. Clinical characteristics and mortality risk factors analysis of heat stroke. West China Medical Journal, 2024, 39(7): 1068-1074. doi: 10.7507/1002-0179.202406088 Copy

1.	宋青, 毛汉丁, 刘树元. 中暑的定义与分级诊断. 解放军医学杂志, 2019, 44(7): 541-545.
2.	Epstein Y, Yanovich R. Heatstroke. N Engl J Med, 2019, 380(25): 2449-2459.
3.	Martínez-Solanas È, Quijal-Zamorano M, Achebak H, et al. Projections of temperature-attributable mortality in Europe: a time series analysis of 147 contiguous regions in 16 countries. Lancet Planet Health, 2021, 5(7): e446-e454.
4.	Sévellec F, Drijfhout SS. A novel probabilistic forecast system predicting anomalously warm 2018-2022 reinforcing the long-term global warming trend. Nat Commun, 2018, 9(1): 3024.
5.	全军热射病防治专家组, 热射病急诊诊断与治疗专家共识组. 热射病急诊诊断与治疗专家共识(2021 版). 中华急诊医学杂志, 2021, 30(11): 1290-1299.
6.	Summary of Recommendation Statements. Kidney Int Suppl, 2012, 2(1): 8-12.
7.	Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut, 2018, 67(1): 6-19.
8.	Liu SY, Song JC, Mao HD, et al. Expert consensus on the diagnosis and treatment of heat stroke in China. Mil Med Res, 2020, 7(1): 1.
9.	Zheng M, Zhang J, Shi L, et al. Mapping heat-related risks in northern Jiangxi province of China based on two spatial assessment frameworks approaches. Int J Environ Res Public Health, 2020, 17(18): 6584.
10.	Shi L, Wang B, Wu Q, et al. Heatstroke: a multicenter study in Southwestern China. Front Public Health, 2024, 12: 1349753.
11.	Iba T, Connors JM, Levi M, et al. Heatstroke-induced coagulopathy: biomarkers, mechanistic insights, and patient management. EClinicalMedicine, 2022, 44: 101276.
12.	Wang L, Jia H, Shen Y, et al. Diagnostic significance of combined calcitoninogen, platelet, and D-dimer assay in severe heatstroke: with clinical data analysis of 70 patients with severe heatstroke. Ther Hypothermia Temp Manag, 2023, 13(1): 29-37.
13.	Wang C, Yu B, Chen R, et al. Association of D-dimer and acute kidney injury associated with rhabdomyolysis in patients with exertional heatstroke: an over 10-year intensive care survey. Ren Fail, 2021, 43(1): 1561-1568.
14.	宋景春, 宋青, 张伟, 等. 热射病性凝血病诊疗中国专家共识. 解放军医学杂志, 2023, 48(11): 1237-1247.
15.	Xue L, Guo W, Li L, et al. Metabolomic profiling identifies a novel mechanism for heat stroke-related acute kidney injury. Mol Med Rep, 2021, 23(4): 241.
16.	Lin MT. Heatstroke-induced cerebral ischemia and neuronal damage. Involvement of cytokines and monoamines. Ann N Y Acad Sci, 1997, 813: 572-580.
17.	Zuckerman GB, Singer LP, Rubin DH, et al. Effects of dantrolene on cooling times and cardiovascular parameters in an immature porcine model of heatstroke. Crit Care Med, 1997, 25(1): 135-139.
18.	Zhong L, Wu M, Liu ZY, et al. Risk factors for brain injury in patients with exertional heatstroke: a 5-year experience. Chin J Traumatol, 2024, 27(2): 91-96.

1. 宋青, 毛汉丁, 刘树元. 中暑的定义与分级诊断. 解放军医学杂志, 2019, 44(7): 541-545.
2. Epstein Y, Yanovich R. Heatstroke. N Engl J Med, 2019, 380(25): 2449-2459.
3. Martínez-Solanas È, Quijal-Zamorano M, Achebak H, et al. Projections of temperature-attributable mortality in Europe: a time series analysis of 147 contiguous regions in 16 countries. Lancet Planet Health, 2021, 5(7): e446-e454.
4. Sévellec F, Drijfhout SS. A novel probabilistic forecast system predicting anomalously warm 2018-2022 reinforcing the long-term global warming trend. Nat Commun, 2018, 9(1): 3024.
5. 全军热射病防治专家组, 热射病急诊诊断与治疗专家共识组. 热射病急诊诊断与治疗专家共识(2021 版). 中华急诊医学杂志, 2021, 30(11): 1290-1299.
6. Summary of Recommendation Statements. Kidney Int Suppl, 2012, 2(1): 8-12.
7. Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut, 2018, 67(1): 6-19.
8. Liu SY, Song JC, Mao HD, et al. Expert consensus on the diagnosis and treatment of heat stroke in China. Mil Med Res, 2020, 7(1): 1.
9. Zheng M, Zhang J, Shi L, et al. Mapping heat-related risks in northern Jiangxi province of China based on two spatial assessment frameworks approaches. Int J Environ Res Public Health, 2020, 17(18): 6584.
10. Shi L, Wang B, Wu Q, et al. Heatstroke: a multicenter study in Southwestern China. Front Public Health, 2024, 12: 1349753.
11. Iba T, Connors JM, Levi M, et al. Heatstroke-induced coagulopathy: biomarkers, mechanistic insights, and patient management. EClinicalMedicine, 2022, 44: 101276.
12. Wang L, Jia H, Shen Y, et al. Diagnostic significance of combined calcitoninogen, platelet, and D-dimer assay in severe heatstroke: with clinical data analysis of 70 patients with severe heatstroke. Ther Hypothermia Temp Manag, 2023, 13(1): 29-37.
13. Wang C, Yu B, Chen R, et al. Association of D-dimer and acute kidney injury associated with rhabdomyolysis in patients with exertional heatstroke: an over 10-year intensive care survey. Ren Fail, 2021, 43(1): 1561-1568.
14. 宋景春, 宋青, 张伟, 等. 热射病性凝血病诊疗中国专家共识. 解放军医学杂志, 2023, 48(11): 1237-1247.
15. Xue L, Guo W, Li L, et al. Metabolomic profiling identifies a novel mechanism for heat stroke-related acute kidney injury. Mol Med Rep, 2021, 23(4): 241.
16. Lin MT. Heatstroke-induced cerebral ischemia and neuronal damage. Involvement of cytokines and monoamines. Ann N Y Acad Sci, 1997, 813: 572-580.
17. Zuckerman GB, Singer LP, Rubin DH, et al. Effects of dantrolene on cooling times and cardiovascular parameters in an immature porcine model of heatstroke. Crit Care Med, 1997, 25(1): 135-139.
18. Zhong L, Wu M, Liu ZY, et al. Risk factors for brain injury in patients with exertional heatstroke: a 5-year experience. Chin J Traumatol, 2024, 27(2): 91-96.

West China Medical Journal

Clinical characteristics and mortality risk factors analysis of heat stroke

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