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Risk factors for brain injury in patients with exertional heatstroke:A 5-year experience

Chinese Journal of Traumatology 2024年第2期27卷 91-96页

作者： Li Zhong Ming Wu Zhe-Ying Liu Yan Liu Zhi-Feng Liu Department of Traditional Chinese Medicine The First Affiliated HospitalGuizhou University of Chinese MedicineGuiyang550001China Department of Infection and Critical Care Medicine The Second People's Hospital of Shenzhen&First Affiliated Hospital of Shenzhen UniversityHealth Science CenterShenzhenGuangdong province518035China Department of Medical Critical Care Medicine General Hospital of Southem Theatre Command of PLA.Guangzhou510010China Guangdong Branch Center National Clinical Research Center for Geriatric Diseases(Chinese PLA General Hospital)Guangzhou510010China

Purpose:Minimal data exist on brain injury in patients with exertional heatstroke(EHS)in developing country.In this study,we explored the risk factors for brain injury induced by EHS 90-day after onset.Methods:A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019.Patients were divided into non-brain injury(fully recovered)and brain injury groups(comprising deceased patients or those with neurological sequelae).The brain injury group was further subdivided into a death group and a sequela group for detailed analysis.General information,neurological performance and information on important organ injuries in the acute stage were recorded and analysed.Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury,and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.Results:Out of the 147 EHS patients,117 were enrolled,of which 96(82.1%)recovered,13(11.1%)died,and 8(6.8%)experienced neurological sequelae.Statistically significant differences were found between non-brain injury and brain injury groups in age,hypotension,duration of consciousness disorders,time to drop core body temperature below 38.5℃,lymphocyte counts,platelet counts,procalcitonin,alanine aminotransferase,aspartate aminotransferase,creatinine,cystatin C,coagulation parameters,international normalized ratio,acute physiology and chronic health evaluation II scores,sequential organ failure assessment(SOFA)scores,and Glasgow coma scale scores(all p<0.05).Multivariate logistic regression showed that age(OR=1.090,95%CI:1.02-1.17,p=0.008),time to drop core temperature(OR=8.223,95%CI:2.30-29.40,p=0.001),and SOFA scores(OR=1.676,95%CI:1.29-2.18,p<0.001)are independent risk factors for brain injury induced by EHS.The Kaplan-Meier curves suggest significantly prolonged survival(p<0.001)in patients with

关键词： exertional heatstroke Brain injury Sequela Risk factors Disorders of consciousness

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Serum procalcitonin levels are associated with rhabdomyolysis following exertional heatstroke: an over 10-year intensive care survey

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World Journal of Emergency Medicine 2024年第1期15卷 23-27页

作者： Li Zhong Feifei Shuai Conglin Wang Lipeng Han Zhifeng Liu Ming Wu Department of Traditional Chinese Medicine the First Affi liated HospitalGuizhou University of Chinese MedicineGuiyang 550001China Department of Medical Critical Care Medicine General Hospital of Southern Theatre Command of People’s Liberation ArmyGuangzhou 510010China Department of Infection and Critical Care Medicine Shenzhen Second People’s Hospital&First Affi liated Hospital of Shenzhen UniversityHealth Science CenterShenzhen 518035China Department of Nosocomial Infection Prevention and Control Shenzhen Second People’s HospitalShenzhen 518035China Key Laboratory of Hot Zone Trauma Care and Tissue Repair of People's Liberation Army General Hospital of Southern Theatre Command of People's Liberation ArmyGuangzhou 510010China

BACKGROUND:heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.

关键词： Procalcitonin Myoglobin Rhabdomyolysis exertional heatstroke

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A nomogram based on lymphocyte percentage for predicting hospital mortality in exertional heatstroke patients: a 13-year retrospective study

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World Journal of Emergency Medicine 2023年第6期14卷 434-441页

作者： Jiale Yang Fanghe Gong Xuezhi Shi Fanfan Wang Jing Qian Lulu Wan Yi Chen Huaisheng Chen Huasheng Tong Guangzhou University of Chinese Medicine Guangzhou 510006China Department of Intensive Care Unit General Hospital of Southern Theatre Command of PLAGuangzhou 510010China Department of Neurosurgery General Hospital of Southern Theatre Command of PLAGuangzhou 510010China Department of Intensive Care Unit Dongguan Binhaiwan Central HospitalDongguan 523900China Department of Critical Care Medicine Shenzhen People's HospitalShenzhen 518020China

BACKGROUND: exertional heatstroke(EHS) is a life-threatening disease without ideal prognostic markers for predicting hospital mortality.METHODS: This is a single-center retrospective study. Clinical data from EHS patients admitted to the Intensive Care Unit(ICU) of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed. Univariate and multivariate logistic regression were used to identify the factors for mortality. The prediction model was developed with the prognostic markers, and a nomogram was established.RESULTS: The study ultimately enrolled 156 patients, and 15(9.6%) of patients died before discharge. The lymphocyte count(Lym) and percentage(Lym%) were significantly lower in nonsurvivors(P<0.05). The univariate and multivariate logistic regression analyses indicated that Lym% at the third day of admission(Lym% D3)(OR=0.609, 95%CI: 0.454–0.816) and hematocrit(HCT)(OR=0.908, 95%CI: 0.834–0.988) were independent protective factors for hospital mortality. A nomogram incorporating Lym% D3 with HCT was developed and demonstrated good discrimination and calibration ability. The comparison between the prediction model and scoring systems revealed that the prediction model had the largest area under the curve(AUC)(0.948, 95%CI: 0.900–0.977), with 100.00% sensitivity and 83.69% specificity, and a greater clinical net benefit.CONCLUSION: Severe EHS patients had a higher risk of experiencing prolonged lymphopenia. A nomogram based on Lym% D3 and HCT was developed to facilitate early identification and timely treatment of patients with potentially unfavorable prognoses.

关键词： exertional heatstroke Lymphopenia Nomogram Prognosis

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Characteristics and Outcome of exertional heatstroke Patients Complicated by Acute Hepatic Injury:A Cohort Study

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Journal of Clinical and Translational Hepatology 2021年第5期9卷 655-660页

作者： Jingjing Ji Jinghua Gao Conglin Wang Leifang Ouyang Zheying Liu Zhifeng Liu Department of Critical Care Medicine General Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA General Hospital of Southern Theater Command of PLAGuangzhouGuangdongChina

Background and Aims:exertional heatstroke(EHS)is associated with strenuous physical activity in hot environments.The present study aimed to investigate dynamic changes of hepatic function indices in EHS patients and determine risk factors for death.Methods:This single-center retrospective cohort study considered all patients with EHS admitted to the intensive care unit at the General Hospital of Southern Theater Command of PLA from October 2008 to May 2019.Data on general characteristics,organ function parameters,and the 90-day outcome of enrolled patients were collected.Hepatic indices were collected dynamically,and patients with acute hepatic injury(AHI)were identified by plasma total bilirubin(TBIL)≥34.2μmol/L and an international normalized ratio≥1.5,or with any grade of hepatic encephalopathy.Results:In patients who survived,TBIL,alanine aminotransferase and aspartate aminotransferase were increased at 24 h,peaked at 2–3 days,and began to decrease at 5 days.In non-survivors,TBIL continuously increased post-admission.The area under the receiver operating characteristic curve for the prediction of mortality based on sequential organ failure assessment(SOFA)scores was 89.8%,and the optimal cutoff value was 7.5.Myocardial injury and infection were identified as independent risk factors for death in EHS patients with AHI.Conclusions:In EHS patients,hepatic dysfunction usually occurred within 24 h.Patients with AHI had more severe clinical conditions,and significantly increased 90-day mortality rates.SOFA scores over 7.5,complicated with myocardial injury or infection,were found to be risk factors for death in EHS patients with AHI.

关键词： exertional heatstroke Acute hepatic injury Mortality TBIL SOFA

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