Prognostic factors in non-exertional heatstroke
Prognostic factors in non-exertional heatstroke
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DOI：
10.1007/s00134-009-1694-y
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发表时间：
2010-02-01
影响因子：
38.9
通讯作者：
Riou, Bruno
中科院分区：
文献类型：
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作者：
Hausfater, Pierre;Megarbane, Bruno;Riou, Bruno
旨在确定与热相关疾病死亡率相关的预后因素。在巴黎地区教学医院网络的 16 个急诊科 (ED) 中进行的多中心观察性队列研究。该队列包括 2003 年 8 月巴黎热浪期间入住急诊科且核心温度 > 38.5°C 的所有患者。记录了急诊科的基线临床和生物学数据、患者病程和 1 年生存率。通过 Cox 比例风险分析评估与死亡相关的潜在预后因素。总共纳入 1,456 名患者。平均年龄为 79 +/- 19 岁。 391 名患者 (27%) 病情危重，但只有 72 名患者 (5%) 被送入重症监护室。 1 年生存率为 57%，而预期为 90% (P < 0.001)。确定了九个独立的预后因素：既往接受过利尿剂治疗、居住在机构中、年龄 > 80 岁、心脏病、癌症、核心温度 > 40A 摄氏度、收缩动脉压 < 100 mmHg、格拉斯哥昏迷评分 < 12 以及由救护车送往医院。我们定义了三个风险组：低风险、中风险和高风险，1 年生存率分别为 85%、61% 和 18%。我们观察到低生存率，并根据容易获得的变量制定了风险评分，这可能对临床医生处理未来热浪造成的伤亡有帮助。
To identify the prognostic factors associated with mortality in heat-related illness.Multi-center observational cohort-study in 16 emergency departments (ED) belonging to the teaching hospital network of the Paris area. The cohort comprised all patients admitted to one of the EDs during the August 2003 heat wave in Paris and having a core temperature > 38.5A degrees C. Baseline clinical and biological data in ED, patient's course and 1-year survival rate were recorded. Potential prognostic factors associated with death were assessed by Cox proportional-hazards analysis.A total of 1,456 patients were included. Mean age was 79 +/- A 19 years. Critically ill conditions were noted in 391 patients (27%), but only 72 (5%) were admitted into an intensive care unit. The survival rate was 57% at 1 year as compared to an expected 90% (P < 0.001). Nine independent prognostic factors were identified: previous treatment with diuretics, living in an institution, age > 80 years, cardiac disease, cancer, core temperature > 40A degrees C, systolic arterial pressure < 100 mmHg, Glasgow coma scale < 12 and transportation to hospital by ambulance. We defined three risk groups: low, intermediate and high risk, with a 1-year survival rate of 85, 61 and 18%, respectively.We observed a low survival rate and developed a risk score based on easily obtained variables that may be useful to clinicians managing casualties from future heat waves.