CTTP Reflects the Severity and Prognosis of Heat Stroke
26 Pages Posted: 15 Jan 2019More...
Background: Temperature control plays a pivotal role in patients with heat stroke (HS), but little work has been done sufficiently on the use of temperature control to reflect disease progression. Here, we defined and analyzed the concrete role of effective controlling time for core temperature to physiological level (CTTP), in order to explore a potential index to guide the diagnosis and treatment of HS.
Method: According to Chinese physical characteristics and the consensus of chinese experts, we defined CTTP as time interval of HS onset to stabilization of core temperature (rectal temperature) below 37.7℃. From 2010.01 to 2018.06 in our hospital, we collected a total of 28 HS cases with clinical diagnosis and treatment records for analyzing the correlation between CTTP and organ injuries, prognosis, APACHE II score and other indices.
Results: There was a significant growth of exertional HS cases year by year, whereas the hospital mortality remained steady over the years, with an overall mortality rate being 17.85%. After analyzing the basic characteristics of CTTP, we found that it didn't obey normal distribution (P<0.05), with its median (P25, P75) being 11.5 (5, 37.5) h. Compared with Srvival group, Death group had obviously higher levels in mean and median of CTTP, APACHE II score and percentage of patients transferred from outside to our hospital (P≤0.05). On the contrary, there were no differences between groups regarding gender, age, blood lipid abnormality, smoking history, drinking history, hypertension history, cerebral stroke history and other factors (P>0.05). Moreover, CTTP length determined the number of damaged organs (r=0.494, P=0.008). The top five of damaged organs in HS patients were central nervous system disorder (100%), liver injury (78.57%), renal injury (67.86%), myocardial injury (57.14%) and blood coagulation disorder (53.57%). Furthermore, some patients with organ injuries, such as renal function impairment, myocardial damage, pulmonary infection, had both higher mean and median of CTTP than the couterpart (P<0.05); in contrast, for other patients with organ injuries, such as liver injury, blood coagulation disorders, rhabdomyolysis, shock, gastrointestinal hemorrhage, respiratory failure, the mean and median of CTTP showed no statistical discrepancy, when compared with the couterpart (P>0.05). Most importantly, CTTP was closely correlated with APACHE II score (r=0.888, P<0.001).
Conclusion To reduce core body temperature early and rapidly with preventive measures against rebound lays the foundation for HS treatment. CTTP is an efficient indicator for assessing the severity and prognosis of HS. The injury in some organs (such as heart, lung and kidney) is in a CTTP-dependent manner, and these patients can benefit remarkably from CTTP control.
Funding Statement: This work was supported by grants from the Science Fund for Distinguished Young Scholars of Sichuan Province (No.2017JQ0012), National Science Funds of China (No.81500208), China Postdoctoral Science Foundation (No.2017M613429), Youth Programme for PLA (17QNP047).
Declaration of Interests: No competing financial interests exist.
Ethics Approval Statement: The Institutional Review Board of Chengdu Military General Hospital approved this study and waived the requirement of informed consent, and we confirmed that all analyses followed the relevant guidelines and regulations.
Keywords: Heat stroke; CTTP; Organ injury; Prognosis; APACHE II score
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