Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis

Meng-Meng Yang; Lu Wang; Yu Zhang; Rui Yuan; Yan Zhao; Jie Hu; Fei-Hu Zhou; Hong-Jun Kang

doi:10.1186/s40779-020-00269-1

Your Location：

Home >

Browse articles >

Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis

RESEARCH | Updated：2023-02-28

- Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis
- Military Medical Research Vol. 8, Issue 1, Pages: 48-61(2021)
- Affiliations：
  
  1.Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, China
  2.Medical School of Chinese PLA, Beijing, China
- Author bio：
  
  * doctorkang301@126.com; doctorkang301@163.com
- Funds：
- DOI：10.1186/s40779-020-00269-1
  CLC：
- Published：2021-03
- Accepted：
Scan QR Code
Yang et al.: Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis. Mil Med Res, 2020, 7: 40.
DOI：

Yang et al.: Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis. Mil Med Res, 2020, 7: 40. DOI： 10.1186/s40779-020-00269-1.

摘要

Abstract

Background:

Heat stroke (HS) is a serious

life-threatening disease. However

there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke (EHS).

Methods:

Data were collected from a total of 170 exertional heat stroke (EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic (ROC) curve (AUC) were used to screen exertional heat stroke score (EHSS) parameters

including but not limited body temperature (T)

Glasgow Coma Scale (GCS) and others. By comparing the sizes of the AUCs of the APACHE II

SOFA and EHSS assessments

the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.

Results:

Through screening with a series of methods

as described above

the present study determined 12 parameters – body temperature (T)

GCS

lactate (Lac)

platelet count (PLT)

prothrombin time (PT)

fibrinogen (Fib)

troponin I (TnI)

aspartate aminotransferase (AST)

total bilirubin (TBIL)

creatinine (Cr) and acute gastrointestinal injury (AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low (EHSS<20) and high scores (EHSS>35) showed 100% survival and 100% mortality

respectively. We found that AUCEHSS>AUCSOFA>AUCAPACHE II.

Conclusions:

A total of 12 parameters – T

GCS

Lac

PLT

Fib

TnI

AST

TBIL

Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases

the mortality rate of EHS patients gradually increases.

关键词

Keywords

references

Leon LR , Bouchama A . Heat stroke . Compr Physiol. 2015 ; 5 ( 2 ): 611 – 47 .

Inoue N , Sato A , Ikawa Y , Shimizu M , Okajima M , Taniguchi T , et al . Successful treatment of exertional heat stroke using continuous plasma diafiltration . J Clin Apher. 2016 ; 31 ( 5 ): 490 – 2 .

Fan H , Zhu JH , Ye JH . Cold hemodiafiltration for exertional heat stroke resulting in multiple organ failure . Ther Apher Dial. 2015 ; 19 ( 5 ): 522 .

Yeo TP . Heat stroke: a comprehensive review . AACN Clin Issues. 2004 ; 15 ( 2 ): 280 – 93 .

Goforth CW , Kazman JB . Exertional heat stroke in navy and marine personnel: a hot topic . Crit Care Nurse. 2015 ; 35 ( 1 ): 52 – 9 .

Keegan MT , Gajic O , Afessa B . Severity of illness scoring systems in the intensive care unit . Crit Care Med. 2011 ; 39 ( 1 ): 163 – 9 .

Vincent JL , Moreno R . Clinical review: scoring systems in the critically ill . Crit Care. 2010 ; 14 ( 2 ): 207 .

Ranson JH , Rifkind KM , Roses DF , Fink SD , Eng K , Localio SA . Objective early identification of severe acute pancreatitis . Am J Gastroenterol. 1974 ; 61 ( 6 ): 443 – 51 .

Hongjun K , Qing S , Yan Z , Liang P , Hui L , Feihu Z . Fluid resuscitation and standard drug treatment strategies in heatstroke Chinese patients . Drug Res (Stuttg). 2015 ; 65 ( 1 ): 18 – 23 .

Pease S , Bouadma L , Kermarrec N , Schortgen F , Regnier B , Wolff M . Early organ dysfunction course, cooling time and outcome in classic heatstroke . Intensive Care Med. 2009 ; 35 ( 8 ): 1454 – 8 .

Knapik JJ , Epstein Y . Exertional heat stroke: pathophysiology, epidemiology, diagnosis, treatment, and prevention . J Spec Oper Med. 2019 ; 19 ( 2 ): 108 – 16 .

King MA , Leon LR , Mustico DL , Haines JM , Clanton TL . Biomarkers of multiorgan injury in a preclinical model of exertional heat stroke . J Appl Physiol (1985). 2015 ; 118 ( 10 ): 1207 – 20 .

Knaus WA , Draper EA , Wagner DP , Zimmerman JE . APACHE II: a severity of disease classification system . Crit Care Med. 1985 ; 13 ( 10 ): 818 – 29 .

Vincent JL , Moreno R , Takala J , Willatts S , De Mendonca A , Bruining H , et al . The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on Sepsis-related problems of the European Society of Intensive Care Medicine . Intensive Care Med. 1996 ; 22 ( 7 ): 707 – 10 .

Le Gall JR , Lemeshow S , Saulnier F . A new simplified acute physiology score (SAPS II) based on a European/north American multicenter study . JAMA. 1993 ; 270 ( 24 ): 2957 – 63 .

Marshall JC , Cook DJ , Christou NV , Bernard GR , Sprung CL , Sibbald WJ . Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome . Crit Care Med. 1995 ; 23 ( 10 ): 1638 – 52 .

Varghese GM , John G , Thomas K , Abraham OC , Mathai D . Predictors of multi-organ dysfunction in heatstroke . Emerg Med J. 2005 ; 22 ( 3 ): 185 – 7 .

Zeller L , Novack V , Barski L , Jotkowitz A , Almog Y . Exertional heatstroke: clinical characteristics, diagnostic and therapeutic considerations . Eur J Intern Med. 2011 ; 22 ( 3 ): 296 – 9 .

Del Bene VE . Temperature . In: Walker HK , Hall WD , Hurst JW , editors . Clinical methods: the history, physical, and laboratory examinations . Boston : Butterworth Publishers, a division of Reed Publishing ; 1990 .

Reintam Blaser A , Malbrain ML , Starkopf J , Fruhwald S , Jakob SM , De Waele J , et al . Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM working group on abdominal problems . Intensive Care Med. 2012 ; 38 ( 3 ): 384 – 94 .

People’s Liberation Army Professional Committee of Critical Care Medicine Expert consensus on the diagnosis and treatment of heat stroke in China . Mil Med Res. 2020 ; 7 : 1 .

Devika S , Jeyaseelan L , Sebastian G . Analysis of GW. Get (window,"data") in logistic regression in medical research: a newer approach . J Postgrad Med. 2016 ; 62 ( 1 ): 26 – 31 .

Pan ZG , Shao Y , Liu YN , Gu ZT , Zhang XQ , Xu YQ , et al . Relationship between early coagulability parameters at admission and outcome in patients with severe heatstroke . Chin Crit Care Med. 2013 ; 25 ( 12 ): 725 – 8 .

Danese E , Montagnana M . An historical approach to the diagnostic biomarkers of acute coronary syndrome . Ann Transl Med. 2016 ; 4 ( 10 ): 194 .

Sekulic AD , Trpkovic SV , Pavlovic AP , Marinkovic OM , Ilic AN . Scoring systems in assessing survival of critically ill ICU patients . Med Sci Monit. 2015 ; 21 : 2621 – 9 .

Naqvi IH , Mahmood K , Ziaullaha S , Kashif SM , Sharif A . Better prognostic marker in ICU - APACHE II, SOFA or SAP II! Pak J Med Sci. 2016 ; 32 ( 5 ): 1146 – 51 .

Stevens TA , Carroll MA , Promecene PA , Seibel M , Monga M . Utility of acute physiology, age, and chronic health evaluation (APACHE III) score in maternal admissions to the intensive care unit . Am J Obstet Gynecol. 2006 ; 194 ( 5 ): e13 – 5 .

Ryan HM , Sharma S , Magee LA , Ansermino JM , MacDonell K , Payne BA , et al . The usefulness of the APACHE II score in obstetric critical care: a structured review . J Obstet Gynaecol Can. 2016 ; 38 ( 10 ): 909 – 18 .

Trujillo MH , Bellorin-Font E , Fragachan CF , Perret-Gentil R . Multiple organ failure following near fatal exertional heat stroke . J Intensive Care Med. 2009 ; 24 ( 1 ): 72 – 8 .

Bouchama A , Knochel JP . Heat stroke . N Engl J Med. 2002 ; 346 ( 25 ): 1978 – 88 .

Hall DM , Buettner GR , Oberley LW , Xu L , Matthes RD , Gisolfi CV . Mechanisms of circulatory and intestinal barrier dysfunction during whole body hyperthermia . Am J Physiol Heart Circ Physiol. 2001 ; 280 ( 2 ): H509 – 21 .

Bouchama A , Parhar RS , El-Yazigi A , Sheth K , Al-Sedairy S . Endotoxemia and release of tumor necrosis factor and interleukin 1 alpha in acute heatstroke . J Appl Physiol (1985). 1991 ; 70 ( 6 ): 2640 – 4 .

Liu V , Morehouse JW , Soule J , Whippy A , Escobar GJ . Fluid volume, lactate values, and mortality in sepsis patients with intermediate lactate values . Ann Am Thorac Soc. 2013 ; 10 ( 5 ): 466 – 73 .

Zhang Z , Chen K , Ni H , Fan H . Predictive value of lactate in unselected critically ill patients: an analysis using fractional polynomials . J Thorac Dis. 2014 ; 6 ( 7 ): 995 – 1003 .

Vincent JL , Quintairos ESA , Couto L Jr , Taccone FS . The value of blood lactate kinetics in critically ill patients: a systematic review . Crit Care. 2016 ; 20 ( 1 ): 257 .

Haas SA , Lange T , Saugel B , Petzoldt M , Fuhrmann V , Metschke M , et al . Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients . Intensive Care Med. 2016 ; 42 ( 2 ): 202 – 10 .

McMahon GM , Zeng X , Waikar SS . A risk prediction score for kidney failure or mortality in rhabdomyolysis . JAMA Intern Med. 2013 ; 173 ( 19 ): 1821 – 8 .

Bouchama A , Hammami MM , Haq A , Jackson J . al-Sedairy S. Evidence for endothelial cell activation/injury in heatstroke . Crit Care Med. 1996 ; 24 ( 7 ): 1173 – 8 .

Hausfater P , Doumenc B , Chopin S , Le Manach Y , Santin A , Dautheville S , et al . Elevation of cardiac troponin I during non-exertional heat-related illnesses in the context of a heatwave . Crit Care. 2010 ; 14 ( 3 ): R99 .

Tang J , Jiang Y , Tang Y , Chen B , Sun X , Su L , et al . Effects of propofol on damage of rat intestinal epithelial cells induced by heat stress and lipopolysaccharides . Braz J Med Biol Res. 2013 ; 46 ( 6 ): 507 – 12 .

Wang YH , Liu TT , Kung WM , Chen CC , Wen YT , Lin IC , et al . Expression of aquaporins in intestine after heat stroke . Int J Clin Exp Pathol. 2015 ; 8 ( 8 ): 8742 – 53 .

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

Exosome autoantibody biomarkers for detection of lung cancer

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

Identification of the lymph node metastasis atlas and optimal lymph node dissection strategy in patients with resectable lung invasive mucinous adenocarcinoma: a real-world multicenter study

China stroke surveillance report 2021

Simulation Analysis of Girder Transport Process on the Box Girder of Hangzhou Bay Bridge

Related Author

Nur Diana Anuar

Boon Cher Goh

Ling-Zhi Wang

Jonathan M. Blackburn

Ross Soo

Andrea Li-Ann Wong

John Kit Chung Tam

Gautam Sethi

Related Institution

Cancer Science Institute of Singapore, National University of Singapore

Sengenics Corporation, Jalan Kerinchi, Bangsar South

Department of Haematology-Oncology, National University Cancer Institute, National 17 University Health System

Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 15 1E Kent Ridge Road

NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore

⁰