Kuo Wan-Yin, Huang Chien-Cheng, Hsu Chien-Chin, Lin Hung-Jung, Su Shih-Bin, Liu Chung-Feng, Sung Mei-I, Chen Chi-An, Guo How-Ran
School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Arch Acad Emerg Med. 2025 Aug 5;13(1):e64. doi: 10.22037/aaemj.v13i1.2710. eCollection 2025.
Acute respiratory failure (ARF) is a critical complication of heat-related illness (HRI). This study aimed to identify predictors of HRI-induced ARF in patients presenting to the emergency department (ED).
Patients aged 20 years and above diagnosed with HRI (ICD-9-CM code 992 or ICD-10 code T67) who visited the EDs of the three hospitals in Tainan, Taiwan between January 2010 and October 2021, were included. Demographic characteristics, comorbidities, and laboratory data were collected. Logistic regression models using the backward elimination method were constructed to identify the independent predictors of HRI-induced ARF.
820 patients with the mean age of 50.0 ± 18.4 years were studied (80.0% male). 29 (3.5%) cases experienced ARF. Patients with ARF were less likely to walk on arrival compared to those without it (27.6% vs. 61.8%, p < 0.001). Additionally, they had higher prevalence of Glasgow Coma Scale (GCS) scores ≤ 8 (p = 0.003), respiratory rate > 20 breaths/min (p < 0.001), body temperature ≥ 40°C (p < 0.001), hypertension (p = 0.001), cerebrovascular disease (p = 0.001), and chronic obstructive pulmonary disease (p = 0.042). The multivariable logistic regression revealed that body temperature ≥ 40 °C on arrival (odds ratio (OR): 7.76; 95% confidence interval (CI): 3.14-19.15), an initial respiratory rate > 20 breaths/min (OR: 8.19; 95% CI: 3.48-19.24), and history of hypertension (OR: 3.38; 95% CI: 1.52-7.52) were predictors of HRI-induced ARF.
Elevated body temperature, respiratory rate, and a history of hypertension were key predictors of ARF in HRI patients, aiding in patient stratification for emergency care.
急性呼吸衰竭（ARF）是热相关疾病（HRI）的一种严重并发症。本研究旨在确定急诊科就诊的热相关疾病患者发生热相关疾病诱发急性呼吸衰竭的预测因素。
纳入2010年1月至2021年10月期间在台湾台南三家医院急诊科就诊、年龄在20岁及以上、诊断为热相关疾病（ICD-9-CM编码992或ICD-10编码T67）的患者。收集人口统计学特征、合并症和实验室数据。采用向后剔除法构建逻辑回归模型，以确定热相关疾病诱发急性呼吸衰竭的独立预测因素。
共研究了820例患者，平均年龄为50.0±18.4岁（80.0%为男性）。29例（3.5%）发生急性呼吸衰竭。与未发生急性呼吸衰竭的患者相比，发生急性呼吸衰竭的患者到达时步行的可能性较小（27.6%对61.8%，p<0.001）。此外，他们格拉斯哥昏迷量表（GCS）评分≤8（p=0.003）、呼吸频率>20次/分钟（p<0.001）、体温≥40°C（p<0.001）、高血压（p=0.001）、脑血管疾病（p=0.001）和慢性阻塞性肺疾病（p=0.042）的患病率更高。多变量逻辑回归显示，到达时体温≥40°C（比值比（OR）：7.76；95%置信区间（CI）：3.14-19.15）、初始呼吸频率>20次/分钟（OR：8.19；95%CI：3.48-19.24）和高血压病史（OR：3.38；95%CI：1.52-7.52）是热相关疾病诱发急性呼吸衰竭的预测因素。
体温升高、呼吸频率和高血压病史是热相关疾病患者发生急性呼吸衰竭的关键预测因素，有助于对患者进行分层以便进行紧急护理。
