Department of Critical Care Medicine, The First Affiliated Hospital, Guizhou University of Chinese Medicine, Guiyang, China.
Department of Critical Care Medicine and Infection Prevention and Control, The Second People's Hospital of Shenzhen and First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China.
Shock. 2021 Jan 1;55(1):61-66. doi: 10.1097/SHK.0000000000001589.
Severe heat stroke is a clinical syndrome caused by host stress dysfunction due to heat stress and subsequent life-threatening organ dysfunction. We aimed to explore the early risk factors affecting the 90-day prognosis of severe heat stroke patients.
A case-control study was used to retrospectively analyze the clinical data of 117 severe heat stroke patients admitted to the intensive care unit of the General Hospital of Southern Theater Command from April 2014 to May 2019. The risk factors affecting the 90-day mortality of the patients were analyzed, and subgroup analysis was performed comparing the complete recovery and the sequelae subgroups of survivors.
Thirteen patients (11.1%) died within 90 days. The multivariate Cox risk regression model showed that cooling time (HR 4.87; 95% CI: 1.94-12.18; P = 0.001), heart rate (HR 1.04; 95% CI: 1.01-1.09; P = 0.027), and Sequential Organ Failure (SOFA) score (HR 1.41; 95% CI: 1.21-1.65; P < 0.001) were independent risk factors affecting the survival of patients. The area under the Receiver Operating Characteristic (ROC) curve of the combination of cooling time, heart rate, and SOFA score for the prediction of mortality due to severe heat stroke was 98.1% (95% CI 0.957-1.000, P < 0.001), the sensitivity was 96.2%, and the specificity was 92.3%.
The longer the cooling duration, the faster the heart rate at admission, and the higher the SOFA score, the lower the 90-day survival rate was. These three indicators can be used in combination to predict 90-day mortality and poor prognosis in patients with severe heat stroke.
严重中暑是一种临床综合征，由热应激引起的宿主应激功能障碍导致危及生命的器官功能障碍。我们旨在探讨影响严重中暑患者 90 天预后的早期危险因素。
采用病例对照研究，回顾性分析 2014 年 4 月至 2019 年 5 月南方战区总医院重症监护病房收治的 117 例严重中暑患者的临床资料。分析影响患者 90 天死亡率的危险因素，并对幸存者的完全恢复和后遗症亚组进行亚组分析。
13 例（11.1%）患者在 90 天内死亡。多变量 Cox 风险回归模型显示，降温时间（HR 4.87；95%CI：1.94-12.18；P=0.001）、心率（HR 1.04；95%CI：1.01-1.09；P=0.027）和序贯器官衰竭评分（SOFA）（HR 1.41；95%CI：1.21-1.65；P<0.001）是影响患者生存的独立危险因素。降温时间、心率和 SOFA 评分联合预测严重中暑死亡率的受试者工作特征（ROC）曲线下面积为 98.1%（95%CI 0.957-1.000，P<0.001），灵敏度为 96.2%，特异性为 92.3%。
降温时间越长、入院时心率越快、SOFA 评分越高，90 天生存率越低。这三个指标可以联合使用，预测严重中暑患者 90 天死亡率和不良预后。
