Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America.
Defense Health Agency, Falls Church, Virginia, United States of America.
PLoS One. 2020 Mar 4;15(3):e0229616. doi: 10.1371/journal.pone.0229616. eCollection 2020.
The aim of this study was to characterize the time-resolved progression of clinical laboratory disturbances days-following an exertional heat stroke (EHS). Currently, normalization of organ injury clinical biomarker values is the primary indicator of EHS recovery. However, an archetypical biochemical recovery profile following EHS has not been established.
We performed a retrospective analysis of EHS patient records in US military personnel from 2008-2014 using the Military Health System Data Repository (MDR). We focused on commonly reported clinical laboratory analytes measured on the day of injury and all proceeding follow-up visits.
Over the prescribed period, there were 2,529 EHS episodes treated at 250 unique treatment locations. Laboratory results, including a standardized set of blood, serum and urine assays, were analyzed from 0-340 days following the initial injury. Indicators of acute kidney injury, including serum electrolyte disturbances and abnormal urinalysis findings, were most prevalent on the day of the injury but normalized within 24-48hours (creatinine, blood urea nitrogen, and blood and protein in urine). Muscle damage and liver function-associated markers peaked 0-4 days after injury and persisted outside their respective reference ranges for 2-16 days (alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, myoglobin, prothrombin time).
Biochemical recovery from EHS spans a 16-day time course, and markers of end-organ damage exhibit distinct patterns over this period. This analysis underscores the prognostic value of each clinical laboratory analyte and will assist in evaluating EHS patient presentation, injury severity and physiological recovery.
本研究旨在描述热射病（EHS）发作后几天内临床实验室指标的时间进展。目前，器官损伤临床生物标志物值的正常化是 EHS 恢复的主要指标。然而，EHS 后典型的生化恢复模式尚未建立。
我们使用军事健康系统数据仓库（MDR）对 2008-2014 年美国军人的 EHS 患者记录进行了回顾性分析。我们主要关注在受伤当天和所有后续随访就诊时测量的常见报告临床实验室分析物。
在规定的时间段内，有 2529 例 EHS 发作在 250 个独特的治疗地点接受治疗。对从最初损伤后 0-340 天的实验室结果，包括一系列标准化的血液、血清和尿液检测进行了分析。急性肾损伤的指标，包括血清电解质紊乱和异常尿液检查结果，在受伤当天最为常见，但在 24-48 小时内恢复正常（肌酐、血尿素氮和血液及尿液中的蛋白质）。肌肉损伤和肝功能相关标志物在受伤后 0-4 天达到峰值，并在各自的参考范围外持续 2-16 天（丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酸磷酸激酶、肌红蛋白、凝血酶原时间）。
EHS 的生化恢复跨越 16 天的时间过程，终末器官损伤的标志物在此期间呈现出不同的模式。这项分析强调了每个临床实验室分析物的预后价值，并将有助于评估 EHS 患者的表现、损伤严重程度和生理恢复情况。
