title: Predictors of multi-organ dysfunction in heatstroke.
abstract: 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.
authors.affiliation: Christian Medical College, Vellore, Department of Medicine Unit 2, Vellore, India, 632004. georgemvarghese@hotmail.com
authors.forename: G M
authors.initials: GM
authors.lastname: Varghese
authors.forename: G
authors.initials: G
authors.lastname: John
authors.forename: K
authors.initials: K
authors.lastname: Thomas
authors.forename: O C
authors.initials: OC
authors.lastname: Abraham
authors.forename: D
authors.initials: D
authors.lastname: Mathai
mesh_terms: D000138:Acidosis / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D018883:Heat Stroke / Q000150:complications*; D006801:Humans; D008099:Liver / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003402:Creatine Kinase
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