Predictors of multi-organ dysfunction in heatstroke
Predictors of multi-organ dysfunction in heatstroke
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DOI：
10.1136/emj.2003.009365
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发表时间：
2005-03-01
影响因子：
3.1
通讯作者：
Mathai, D
中科院分区：
文献类型：
--
作者：
Varghese, GM;John, G;Mathai, D
背景资料：中暑是一种医疗紧急情况，由体温调节机制失效加上过度的急性期反应引起，导致核心体温升高超过40摄氏度，产生多器官功能障碍。它进行了高死亡率，并在幸存者中，永久性神经损伤的风险。目的：探讨多器官功能障碍综合征的预测因素，在中暑patients presented with heatstroke.Methods：我们调查了28例在印度南部的一家医院在1998年1月至2001年12月期间。使用一个标准的形式，我们收集了患者的特征，实验室数据和结果的数据，并比较那些与多器官功能障碍，没有这样的functions.Results：我们发现，超过四分之三的研究患者发展多器官功能障碍，最常见的功能障碍是呼吸衰竭。在选定的预测因素中，16例患者中有14例发生代谢性酸中毒，占87.5%; p = 0.011，19例患者中有17例CPK升高，占89.5%; p = 0.005，肝酶升高超过正常值的两倍（11/18例，61%; p = 0.02）与两个或多个器官功能障碍的相关性最高。在中暑中观察到的高死亡率继发于多器官功能障碍，并且在评估的各种参数中，高水平的CPK（> 1000 IU/ l）、代谢性酸中毒和升高的肝酶是预测性的。积极的降低体温措施和其他支持治疗可显著降低死亡率。
Background: Heatstroke is a medical emergency that results from failure of thermoregulatory mechanism coupled with an exaggerated acute phase response, causing an elevation in core body temperature that rises above 40 degrees C, producing multi- organ dysfunction. It carries a high mortality rate, and in survivors, a risk of permanent neurological damage.Objective: To investigate predictors of multiple organ dysfunction syndrome in patients presenting with heatstroke.Methods: We investigated 28 patients admitted to a hospital in southern India during the period January 1998 to December 2001. Using a standard form, we collected data on the patients' characteristics, laboratory data, and outcome, and compared those with multiple organ dysfunction with those without such dysfunction.Results: We found that more than three quarters of the studied patients developed multiple organ dysfunction, with the most common dysfunction being respiratory failure. Among the selected predictors, metabolic acidosis 14 of 16 patients, 87.5%; p = 0.011, elevated CPK 17 of 19 patients, 89.5%; p = 0.005, and liver enzymes elevated more than twice the normal ( 11 of 18 patients, 61%; p = 0.02) had the highest correlation with dysfunction of two or more organs.Conclusions: The high mortality observed in heatstroke is secondary to multi- organ dysfunction, and among the various parameters assessed, high levels of CPK (> 1000 IU/ l), metabolic acidosis, and elevated liver enzymes are predictive. Aggressive measures to lower the body temperature with other supportive therapy could substantially reduce the mortality.