Wu Ming, Wang Conglin, Liu Zheying, Zhong Li, Yu Baojun, Cheng Biao, Liu Zhifeng
The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Department of Critical Care Medicine, General Hospital of Southern Theatre Command of People's Liberation Army, Guangzhou, China.
Front Med (Lausanne). 2021 May 19;8:678434. doi: 10.3389/fmed.2021.678434. eCollection 2021.
Exertional heat stroke (EHS) is a life-threatening injury that can lead to acute kidney injury (AKI). The clinical characteristics of and risk factors for EHS complicated with AKI have been poorly documented. A retrospective study with EHS admitted to the intensive care unit (ICU) from January 2008 to June 2019 was performed. Data including baseline clinical information at admission, main organ dysfunction, 90-day mortality and total cost of hospitalization were collected. A total of 187 patients were finally included, of which 82 (43.9%) had AKI. AKI patients had more severe organ injury and higher total hospitalization costs than non-AKI patients. Multivariate logistic analysis showed that lymphocyte, neutrophil, D-dimer and myoglobin (MB) ≥ 1,000 ng/ml were independent risk factors for AKI caused by EHS. In addition, SOFA score [hazard ratio (HR) 4.1, 95% confidence interval (95% CI) 1.6-10.8, = 0.004] and GCS score (HR 3.2, 95% CI 1.2-8.4 = 0.017) were the risk factor for 90-day mortality in patients with EHS complicated with AKI, with an area under the curve (AUC) of 0.920 (95% CI 0.842-0.998, < 0.001) and 0.851 (95% CI 0.739-0.962, < 0.001), respectively. Survival analysis showed that the 90-day mortality in AKI patients was significantly high ( < 0.0001) and the mortality rate of patients with AKI stage 2 was the highest than other stages. EHS complicated with AKI is associated with higher hospitalization costs and poorly clinical outcomes. MB ≥1,000 ng/ml, Inflammation, coagulation were associated with the occurrence and development of AKI. Early treatment strategies based reducing the SOFA and GCS score may be pivotal for improving the prognosis of EHS.
劳力性热射病（EHS）是一种危及生命的损伤，可导致急性肾损伤（AKI）。EHS合并AKI的临床特征和危险因素鲜有文献记载。对2008年1月至2019年6月入住重症监护病房（ICU）的EHS患者进行了一项回顾性研究。收集了包括入院时的基线临床信息、主要器官功能障碍、90天死亡率和住院总费用等数据。最终纳入187例患者，其中82例（43.9%）发生AKI。与非AKI患者相比，AKI患者的器官损伤更严重，住院总费用更高。多因素逻辑回归分析显示，淋巴细胞、中性粒细胞、D-二聚体和肌红蛋白（MB）≥1000 ng/ml是EHS所致AKI的独立危险因素。此外，序贯器官衰竭评估（SOFA）评分[风险比（HR）4.1，95%置信区间（95%CI）1.6-10.8，P = 0.004]和格拉斯哥昏迷量表（GCS）评分（HR 3.2，95%CI 1.2-8.4，P = 0.017）是EHS合并AKI患者90天死亡率的危险因素，曲线下面积（AUC）分别为0.920（95%CI 0.842-0.998，P < 0.001）和0.851（95%CI 0.739-0.962，P < 0.001）。生存分析显示，AKI患者的90天死亡率显著较高（P < 0.0001），且2期AKI患者的死亡率高于其他阶段。EHS合并AKI与更高的住院费用和较差的临床结局相关。MB≥1000 ng/ml、炎症、凝血与AKI的发生发展相关。基于降低SOFA和GCS评分的早期治疗策略可能对改善EHS的预后至关重要。
