Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France
Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France
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DOI：
10.1001/archinte.167.20.ioi70147
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发表时间：
2007-11-12
影响因子：
--
通讯作者：
Robert, Dominique
中科院分区：
文献类型：
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作者：
Argaud, Laurent;Ferry, Tristan;Robert, Dominique
背景：2003年8月，欧洲持续了一场严重的热浪，在法国造成14800人死亡。这些超额死亡大多发生在城市地区，那里的最高气温打破了所有记录。中暑是与热有关的疾病中最严重的一种。在温带countries.Methods的城市地区中暑的临床过程中记录不佳：在法国热浪（2003年8月1日至20日），我们进行了一项前瞻性研究，在一所大学医院位于里昂，在法国最大的大都市地区之一。我们评估了生存和功能的结果为2年，并寻找影响预后的因素。28天和2年死亡率分别为58%和71%。死亡率早在入院时就受到发热程度和器官功能障碍数量的影响。多变量分析显示，如果患者来自医疗机构，（风险比[HR]，1.98; 95%置信区间[CI]，1.05-3.71），使用长期降压药物（HR，2.17; 95% CI，1.17-4.05），或入院时出现无尿（HR，5.24; 95% CI，2.29-12.03）、昏迷（HR，2.95; 95% CI，1.26-6.91）或心血管衰竭（HR，2.43; 95% CI，1.14-5.17）。大多数存活患者在1年和2年时功能状态发生显着变化。结论：在温带城市地区，中暑与不良结局相关。这至少可以部分地解释为我们缺乏经验。西方温带国家需要为未来的热浪做好更多准备。
Background: During August 2003, Europe sustained a severe heat wave that resulted in 14800 heat-related deaths in France. Most of these excess deaths occurred in urban areas, where maximal temperatures broke all records. Heatstroke is the most severe form of heat-related illness. The clinical course of heatstroke in urban areas of temperate countries is poorly documented.Methods: During the French heat wave (August 1-20, 2003), we conducted a prospective study in a university hospital located in Lyon, one of the largest metropolitan areas in France. We evaluated survival and functional outcome for 2 years and looked for factors influencing the prognosis.Results: A total of 83 patients presented with heatstroke. The 28-day and 2-year mortality rates were 58% and 71%, respectively. Mortality was influenced as early as admission by the level of fever and the number of organ dysfunctions. Multivariate analysis revealed an independent contribution to mortality if patients came from an institution (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.05-3.71), used long-term antihypertensive medication (HR, 2.17; 95% CI, 1.17-4.05), or presented at admission with anuria (HR, 5.24; 95% CI, 2.29-12.03), coma (HR, 2.95; 95% CI, 1.26-6.91), or cardiovascular failure (HR, 2.43; 95% CI, 1.14-5.17). Most surviving patients exhibited a dramatic alteration of their functional status at 1 and 2 years.Conclusions: Heatstroke is associated with poor outcomes in temperate urban areas. This could be explained at least in part by our lack of experience. Western temperate countries need to be more prepared for future heat waves.