Department of Traditional Chinese Medicine, The First Affiliated Hospital, Guizhou University of Chinese Medicine, Guiyang, 550001, China.
Department of Infection and Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong province, 518035, China.
Chin J Traumatol. 2024 Mar;27(2):91-96. doi: 10.1016/j.cjtee.2023.10.003. Epub 2023 Nov 3.
Minimal data exist on brain injury in patients with exertional heatstroke (EHS) in developing country. In this study, we explored the risk factors for brain injury induced by EHS 90-day after onset.
A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019. Patients were divided into non-brain injury (fully recovered) and brain injury groups (comprising deceased patients or those with neurological sequelae). The brain injury group was further subdivided into a death group and a sequela group for detailed analysis. General information, neurological performance and information on important organ injuries in the acute stage were recorded and analysed. Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury, and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.
Out of the 147 EHS patients, 117 were enrolled, of which 96 (82.1%) recovered, 13 (11.1%) died, and 8 (6.8%) experienced neurological sequelae. Statistically significant differences were found between non-brain injury and brain injury groups in age, hypotension, duration of consciousness disorders, time to drop core body temperature below 38.5°C, lymphocyte counts, platelet counts, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, cystatin C, coagulation parameters, international normalized ratio, acute physiology and chronic health evaluation II scores, sequential organ failure assessment (SOFA) scores, and Glasgow coma scale scores (all p < 0.05). Multivariate logistic regression showed that age (OR = 1.090, 95% CI: 1.02 - 1.17, p = 0.008), time to drop core temperature (OR = 8.223, 95% CI: 2.30 - 29.40, p = 0.001), and SOFA scores (OR = 1.676, 95% CI: 1.29 - 2.18, p < 0.001) are independent risk factors for brain injury induced by EHS. The Kaplan-Meier curves suggest significantly prolonged survival (p < 0.001) in patients with early Glasgow coma scale score > 8 and duration of consciousness disorders ≤ 24 h.
Advanced age, delayed cooling, and higher SOFA scores significantly increase the risk of brain injury post-EHS. These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.
发展中国家关于运动性中暑（EHS）患者脑损伤的数据很少。本研究旨在探讨 EHS 发病 90 天后脑损伤的危险因素。
对 2014 年 4 月至 2019 年 6 月期间在中国南部战区总医院重症监护病房收治的 EHS 患者进行回顾性队列研究。患者分为无脑损伤（完全康复）和脑损伤组（包括死亡患者或有神经后遗症的患者）。脑损伤组进一步分为死亡组和后遗症组进行详细分析。记录并分析一般信息、神经功能和急性期重要器官损伤信息。多变量逻辑回归用于确定 EHS 后脑损伤的危险因素和脑损伤的死亡危险因素，Kaplan-Meier 生存曲线用于评估神经功能障碍对生存的影响。
147 例 EHS 患者中，117 例入选，其中 96 例（82.1%）康复，13 例（11.1%）死亡，8 例（6.8%）有神经后遗症。无脑损伤组与脑损伤组在年龄、低血压、意识障碍持续时间、核心体温降至 38.5°C 以下的时间、淋巴细胞计数、血小板计数、降钙素原、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、胱抑素 C、凝血参数、国际标准化比值、急性生理学和慢性健康评估 II 评分、序贯器官衰竭评估（SOFA）评分和格拉斯哥昏迷量表评分等方面差异有统计学意义（均 p<0.05）。多变量逻辑回归显示，年龄（OR=1.090，95%CI：1.02-1.17，p=0.008）、核心体温下降时间（OR=8.223，95%CI：2.30-29.40，p=0.001）和 SOFA 评分（OR=1.676，95%CI：1.29-2.18，p<0.001）是 EHS 后脑损伤的独立危险因素。Kaplan-Meier 曲线表明，格拉斯哥昏迷量表评分早期>8 分和意识障碍持续时间≤24 h 的患者生存时间明显延长（p<0.001）。
高龄、降温延迟和更高的 SOFA 评分显著增加 EHS 后脑损伤的风险。这些发现强调了快速降温和早期评估器官衰竭以改善 EHS 患者预后的重要性。
