Predictors of multi-organ dysfunction in heatstroke.
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.
Varghese
G M
GM
Christian Medical College, Vellore, Department of Medicine Unit 2, Vellore, India, 632004. georgemvarghese@hotmail.com
John
G
G
Thomas
K
K
Abraham
O C
OC
Mathai
D
D
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
D003402:Creatine Kinase
N Engl J Med. 1974 Sep 12;291(11):564-7
4604525
JAMA. 1982 Jun 25;247(24):3327-31
7087075
JAMA. 1982 Jun 25;247(24):3332-6
7087076
Lancet. 1988 Sep 3;2(8610):573
2900961
Crit Care Clin. 1989 Apr;5(2):221-32
2650815
Emerg Med Clin North Am. 1992 May;10(2):299-310
1559470
Am J Gastroenterol. 1992 Oct;87(10):1382-9
1415091
N Engl J Med. 1993 Aug 12;329(7):483-7
8332154
Am Fam Physician. 1994 Aug;50(2):389-96, 398
8042574
N Engl J Med. 1996 Jul 11;335(2):84-90
8649494
Ann Intern Med. 1998 Aug 1;129(3):173-81
9696724
Crit Care Clin. 1999 Apr;15(2):251-63
10331127
BMJ. 2000 Sep 16;321(7262):670-3
10987770
N Engl J Med. 2002 Jun 20;346(25):1978-88
12075060
BMJ. 2003 Aug 30;327(7413):465
12946954
Q J Med. 1967 Jul;36(143):277-300
6049763
Q J Med. 1967 Oct;36(144):525-48
6077230
J Appl Physiol. 1970 Apr;28(4):415-20
5437428
Am J Med. 1970 Aug;49(2):192-202
5452941
South Med J. 1973 Mar;66(3):330-3
4691010