Heatstroke-induced coagulopathy: Biomarkers, mechanistic insights, and patient management.
Heatstroke-induced coagulopathy: Biomarkers, mechanistic insights, and patient management.
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DOI：
10.1016/j.eclinm.2022.101276
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发表时间：
2022-03
影响因子：
15.1
通讯作者：
Levy JH
中科院分区：
文献类型：
--
作者：
Iba T;Connors JM;Levi M;Levy JH
由于全球变暖，中暑日益成为一个重要问题。全身炎症和凝血功能障碍是中暑时引发危及生命的器官功能障碍的两个主要因素。温度控制失调会导致细胞损伤、损伤相关分子模式释放、过度炎症和高凝状态，并抑制纤维蛋白溶解，从而产生中暑诱发的凝血病 (HSIC)。如果严重的话，HSIC 可进展为弥散性血管内凝血和多器官衰竭。血小板计数、D-二聚体、可溶性血栓调节蛋白和炎症生物标志物（例如白细胞介素 6 和组蛋白 H3）是有前景的 HSIC 标志物。在劳力性中暑时，测量肌红蛋白有助于预测肾功能障碍。然而，每种生物标志物的最佳截止值尚未确定。除了最初的降温和水合外，有效的治疗方法仍在继续探索，抗炎和抗凝疗法的使用正在研究中。尽管风险迅速增加，但我们的知识有限，有必要进行进一步的研究。在本次审查中，我们研究了当前信息以及未来需要采取哪些努力才能更好地理解和管理 HSIC。
Heatstroke is increasingly becoming a significant concern due to global warming. Systemic inflammation and coagulopathy are the two major factors that provoke life-threatening organ dysfunction in heatstroke. Dysregulated thermo-control induces cellular injury, damage-associated molecular patterns release, hyperinflammation, and hypercoagulation with suppressed fibrinolysis to produce heatstroke-induced coagulopathy (HSIC). HSIC can progress to disseminated intravascular coagulation and multiorgan failure if severe enough. Platelet count, D-dimer, soluble thrombomodulin, and inflammation biomarkers such as interleukin-6 and histone H3 are promising markers for HSIC. In exertional heatstroke, the measurement of myoglobin is helpful to anticipate renal dysfunction. However, the optimal cutoff for each biomarker has not been determined. Except for initial cooling and hydration, effective therapy continues to be explored, and the use of antiinflammatory and anticoagulant therapies is under investigation. Despite the rapidly increasing risk, our knowledge is limited, and further study is warranted. In this review, we examine current information and what future efforts are needed to better understand and manage HSIC.
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