title: Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France.
abstract: BACKGROUND
  During August 2003, Europe sustained a severe heat wave that resulted in 14 800 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.
authors: Service de Réanimation Médicale, Groupement Hospitalier Edouard Herriot, 5 Place d'Arsonval, Lyon CEDEX 03, France. laurent.argaud@chu-lyon.fr
authors: Laurent
authors: L
authors: Argaud
authors: Tristan
authors: T
authors: Ferry
authors: Quoc-Hung
authors: QH
authors: Le
authors: Aurélia
authors: A
authors: Marfisi
authors: Diana
authors: D
authors: Ciorba
authors: Pierre
authors: P
authors: Achache
authors: Roland
authors: R
authors: Ducluzeau
authors: Dominique
authors: D
authors: Robert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D018883:Heat Stroke / Q000401:mortality*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007259:Infrared Rays / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D014505:Urban Population