Wu Ming, Wang Conglin, Liu Zheying, Liu Zhifeng
Department of Critical Care Medicine and Hospital Infection Prevention and Control, Health Science Center, The Second People's Hospital of Shenzhen, First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China.
Front Med (Lausanne). 2021 Oct 11;8:724319. doi: 10.3389/fmed.2021.724319. eCollection 2021.
Heatstroke is a medical emergency that causes multi-organ injury and death without intervention, but limited data are available on the illness scores in predicting the outcomes of exertional heat stroke (EHS) with rhabdomyolysis (RM). The aim of our study was to investigate the Sequential Organ Failure Assessment (SOFA) score in predicting mortality of patients with RM after EHS. A retrospective cohort study was performed, which included all patients with EHS admitted into the intensive care unit (ICU) of General Hospital of Southern Theater Command of Peoples Liberation Army from January 2008 to June 2019. RM was defined as creatine kinase (CK) > 1,000 U/L. Data, including the baseline data at admission, vital organ function indicators, and 90-day mortality, were reviewed. A total of 176 patients were enrolled; among them, 85 (48.3%) had RM. Patients with RM had a significantly higher SOFA score (4.0 vs. 3.0, = 0.021), higher occurrence rates of disseminated intravascular coagulation (DIC) (53.1 vs. 18.3%, < 0.001) and acute liver injury (ALI) (21.4 vs. 5.5%, = 0.002) than patients with non-RM. RM was positively correlated with ALI and DIC, and the correlation coefficients were 0.236 and 0.365, respectively (both -values <0.01). Multivariate logistics analysis showed that the SOFA score [odds ratio (OR) 1.7, 95% CI 1.1-2.6, = 0.024] was the risk factor for 90-day mortality in patients with RM after EHS, with the area under the curve (AUC) 0.958 (95% CI 0.908-1.000, < 0.001) and the optimal cutoff 7.5 points. Patients with RM after EHS have severe clinical conditions, which are often accompanied by DIC or ALI. The SOFA score could predict the prognosis of patients with RM with EHS. Early treatment strategies based on decreasing the SOFA score at admission may be pivotal to reduce the 90-day mortality of patients with EHS.
热射病是一种医疗急症，若不进行干预会导致多器官损伤甚至死亡，但关于疾病评分在预测伴有横纹肌溶解症（RM）的劳力性热射病（EHS）预后方面的数据有限。我们研究的目的是探讨序贯器官衰竭评估（SOFA）评分对EHS后发生RM患者死亡率的预测价值。我们进行了一项回顾性队列研究，纳入了2008年1月至2019年6月期间解放军南部战区总医院重症监护病房（ICU）收治的所有EHS患者。RM定义为肌酸激酶（CK）>1000 U/L。我们回顾了包括入院时的基线数据、重要器官功能指标和90天死亡率在内的数据。共纳入176例患者，其中85例（48.3%）发生RM。发生RM的患者SOFA评分显著更高（4.0对3.0，P = 0.021），弥散性血管内凝血（DIC）（53.1%对18.3%，P<0.001）和急性肝损伤（ALI）（21.4%对5.5%，P = 0.002）的发生率也高于未发生RM的患者。RM与ALI和DIC呈正相关，相关系数分别为0.236和0.365（均P值<0.01）。多因素logistic分析显示，SOFA评分[比值比（OR）1.7，95%置信区间（CI）1.1 - 2.6，P = 0.024]是EHS后发生RM患者90天死亡率的危险因素，曲线下面积（AUC）为0.958（95%CI 0.908 - 1.000，P<0.001），最佳截断值为7.5分。EHS后发生RM的患者临床病情严重，常伴有DIC或ALI。SOFA评分可预测EHS合并RM患者的预后。基于降低入院时SOFA评分的早期治疗策略可能是降低EHS患者90天死亡率的关键。
