Department of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Emerg Med. 2013 Aug;31(8):1176-80. doi: 10.1016/j.ajem.2013.04.030. Epub 2013 May 30.
Heatstroke (HS) is a life-threatening condition, manifested by systemic inflammation and multiorgan failure. Rapid recognition and treatment are life saving. We report a laboratory-oriented characterization of HS by low plasma C-reactive protein (CRP) level and propose its usefulness in distinguishing this type of hyperpyrexia from central nervous system-associated high core temperature.
After institutional review board approval, records of patients admitted to general intensive care unit between August 2008 and September 2011 with core temperature 39.0°C or higher due to HS or meningoencephalitis (ME) were reviewed. Patients' demographics, CRP on admission and 24 to 48 hours later, serum creatinine, creatine phosphokinase, platelets count, international normalized ratio, alanine transaminase, serum pH, and lactate levels were retrieved.
Thirty-six patients were admitted to the intensive care unit with high core temperature: 19 patients, aged 21 to 85 years, had HS; 17 individuals, aged 22 to 81 years, had ME. None of the HS individuals had infection. Twelve HS patients were previously healthy; in 13 patients, the event occurred postexercise. Mean admission CRP levels was 2.1 ± 3.3 mg/L in the HS group compared with 129 ± 84 mg/L in the ME patients (P < .0001); mean 24- to 48-hour CRP levels were 14.6 ± 16.8 vs 139 ± 98 mg/L, respectively (P < .0001). There were no clinically significant differences between the groups regarding laboratory parameters indicative of end-organ damage. Six HS patients underwent computed tomography and/or lumbar puncture before starting intensive cooling, due to misdiagnosis; 5 of them died subsequently.
Low serum CRP levels characterize non-central nervous system-associated HS. This available laboratory test could identify noninfectious hyperthermic patients upon admission, saving precious time until treatment and avoiding unnecessary diagnostic tests.
中暑（HS）是一种危及生命的疾病，表现为全身炎症和多器官衰竭。快速识别和治疗是救命的。我们报告了一种通过低血浆 C 反应蛋白（CRP）水平对 HS 进行的以实验室为导向的特征描述，并提出了其在区分这种类型的高热与中枢神经系统相关的高热核心温度中的有用性。
在机构审查委员会批准后，回顾了 2008 年 8 月至 2011 年 9 月期间因 HS 或脑膜炎（ME）而核心体温为 39.0°C 或更高的入住普通重症监护病房的患者的记录。检索患者的人口统计学数据、入院时和 24 至 48 小时后的 CRP、血清肌酐、肌酸磷酸激酶、血小板计数、国际标准化比值、丙氨酸转氨酶、血清 pH 值和乳酸水平。
36 名患者因高热入住重症监护病房：19 名年龄在 21 至 85 岁之间的患者患有 HS；17 名年龄在 22 至 81 岁之间的个体患有 ME。HS 患者中无一人有感染。12 名 HS 患者既往健康；在 13 名患者中，该事件发生在运动后。HS 组入院时 CRP 水平平均为 2.1 ± 3.3 mg/L，而 ME 患者为 129 ± 84 mg/L（P <.0001）；24 至 48 小时 CRP 水平分别为 14.6 ± 16.8 和 139 ± 98 mg/L（P <.0001）。两组在提示终末器官损伤的实验室参数方面无明显差异。由于误诊，6 名 HS 患者在开始重症降温前进行了计算机断层扫描和/或腰椎穿刺；其中 5 人随后死亡。
低血清 CRP 水平是与中枢神经系统无关的 HS 的特征。这种可用的实验室检测可以在入院时识别非感染性高热患者，节省宝贵的治疗时间，避免不必要的诊断检测。
