Liu Shuyuan, Xing Ling, Wang Qian, Xin Tianyu, Mao Handing, Tao Ye, Zhao Jinbao, Li Xin, Li Cong, Li Qinghua, Dou Yan, Li Yixin, Zhang Wei, Ning Bo, Song Qing
Medical School of Chinese PLA, Beijing, People's Republic of China.
Emergency Department, Sixth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
Int J Gen Med. 2021 Aug 17;14:4629-4638. doi: 10.2147/IJGM.S322910. eCollection 2021.
The purpose of this study is to evaluate the factors involved in the early stage of exertional heat stroke (EHS) that are associated with mortality.
In this retrospective, case-control study, patients from 11 tertiary medical centers in China were enrolled from January 1, 2012, to December 31, 2019. Demographic information, underlying diseases, ambient temperature, and relative humidity, clinical manifestations, initial body temperature, time from onset to diagnosis of EHS (including suspected), and the duration of body temperature > 38°C of all enrolled patients were recorded. The occurrence of organ dysfunction within 72 h was evaluated, and in-hospital deaths were recorded. The patients were subsequently divided into a survival group and a non-survival group. The "case" refers to patients in the non-survival group, while the "control" refers to patients without death.
Of the 214 hospitalized patients with EHS, 183 survived and 31 died, and the overall mortality was 14.49% (31/214). A binary logistic regression showed that only the duration of body temperature > 38°C (OR 1.80, 95% CI 1.34-2.42) and the number of organs damaged within 72 h of onset (OR 6.54, 95% CI 2.31-18.56) were statistically significant in terms of risk of death in hospital (p < 0.05). A goodness of fit test produced a p-value of 0.76. According to receiver operating characteristic curve (ROC) analysis, the areas under the curve (AUC) were 0.989 (95% CI 0.978-1.000; p < 0.05) and 0.936 (95% CI 0.896-0.976; p < 0.05).
Of the various factors involved in the early stage of the disease, the duration of high body temperature and the number of organs damaged within 72 h of onset were independent risk factors and predictors associated with death.
本研究旨在评估劳力性热射病（EHS）早期与死亡率相关的因素。
在这项回顾性病例对照研究中，纳入了2012年1月1日至2019年12月31日期间来自中国11家三级医疗中心的患者。记录所有入选患者的人口统计学信息、基础疾病、环境温度和相对湿度、临床表现、初始体温、从发病到诊断EHS（包括疑似）的时间以及体温>38°C的持续时间。评估72小时内器官功能障碍的发生情况，并记录住院死亡情况。随后将患者分为生存组和非生存组。“病例”指非生存组患者，而“对照”指未死亡患者。
214例住院的EHS患者中，183例存活，31例死亡，总死亡率为14.49%（31/214）。二元逻辑回归显示，就住院死亡风险而言，仅体温>38°C的持续时间（OR 1.80，95%CI 1.34 - 2.42）和发病后72小时内受损器官数量（OR 6.54，95%CI 2.31 - 18.56）具有统计学意义（p < 0.05）。拟合优度检验的p值为0.76。根据受试者工作特征曲线（ROC）分析，曲线下面积（AUC）分别为0.989（95%CI 0.978 - 1.000；p < 0.05）和0.936（95%CI 0.896 - 0.976；p < 0.05）。
在疾病早期涉及的各种因素中，高温持续时间和发病后72小时内受损器官数量是与死亡相关的独立危险因素和预测指标。
