Zhong Li, Liu Yan, Wang Conglin, Liu Zheying, Su Lei, Liu Zhifeng, Wu Ming
Department of Traditional Chinese Medicine, The First Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, China.
Department of Medical Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, Chìna.
Int J Hyperthermia. 2025 Dec;42(1):2535730. doi: 10.1080/02656736.2025.2535730. Epub 2025 Jul 23.
Thrombocytopaenia is a known predictor of poor outcomes in trauma and sepsis patients, its prognostic role in exertional heatstroke (EHS) remains underexplored. This study aimed to evaluate the association between persistent thrombocytopaenia and mortality in critically ill EHS patients.
In this retrospective cohort study, we analyzed data from 217 EHS patients admitted to the intensive care unit (ICU) between November 2009 and October 2023. Demographic, biochemical (baseline, 24 h, and 48 h), and inflammatory marker data were collected. Persistent thrombocytopaenia was defined as a platelet count <100 × 10/L at both 24 h and 48 h postadmission. Multivariate logistic regression identified predictors of 28-day mortality, and Kaplan-Meier survival curves with log-rank tests were used to compare outcomes between groups.
Among the 217 patients, 19 (8.8%) patients died within 28 days. Nonsurvivors presented significantly worse liver/kidney function, coagulopathy (DIC incidence: 89.5% vs. 26.8%, < 0.001), and AKI incidence (100% vs. 38.4%, < 0.01). The platelet counts in nonsurvivors were markedly lower than those in survivors at admission (71 vs. 166 × 10/L), 24 h (49 vs. 134 × 10/L), and 48 h (56 vs. 131 × 10/L) (all < 0.001). Persistent thrombocytopaenia (63 patients, 29.0%) independently predicted mortality (adjusted OR = 17.44, 95% CI: 4.76-63.86; < 0.001) and was correlated with higher DIC (84.1% vs. 11.0%, < 0.001) and AKI (63.5% vs. 35.7%, < 0.001) rates. Survival analysis confirmed significantly increased 28-day mortality in thrombocytopaenia patients (25.4% vs. 1.9%, < 0.001).
Persistent thrombocytopaenia within 48 h of ICU admission is a robust predictor of mortality and multiorgan dysfunction in patients with EHS.
血小板减少症是创伤和脓毒症患者预后不良的已知预测指标，其在劳力性热射病（EHS）中的预后作用仍未得到充分研究。本研究旨在评估危重症EHS患者持续性血小板减少与死亡率之间的关联。
在这项回顾性队列研究中，我们分析了2009年11月至2023年10月期间入住重症监护病房（ICU）的217例EHS患者的数据。收集了人口统计学、生化指标（基线、24小时和48小时）以及炎症标志物数据。持续性血小板减少症定义为入院后24小时和48小时血小板计数均<100×10⁹/L。多因素逻辑回归确定了28天死亡率预测因素，并使用Kaplan-Meier生存曲线和对数秩检验比较组间结局。
在217例患者中，19例（8.8%）在28天内死亡。非幸存者的肝/肾功能、凝血病（弥散性血管内凝血发生率：89.5% 对26.8%，P<0.001）和急性肾损伤发生率（100% 对38.4%，P<0.01）明显更差。非幸存者入院时（71对166×10⁹/L）、24小时（49对134×10⁹/L）和48小时（56对131×10⁹/L）的血小板计数均显著低于幸存者（均P<0.001）。持续性血小板减少症（63例患者，29.0%）独立预测死亡率（调整后的比值比=17.44，95%置信区间：4.76-63.86；P<0.001），并与更高的弥散性血管内凝血（84.1%对11.0%，P<0.001）和急性肾损伤（63.5%对35.7%，P<0.001）发生率相关。生存分析证实血小板减少症患者28天死亡率显著增加（25.4%对1.9%，P<0.001）。
ICU入院后48小时内的持续性血小板减少症是EHS患者死亡率和多器官功能障碍的有力预测指标。
