[Fever as a prognostic factor for heat stroke].
OBJECTIVE
Classic heatstroke that is, due to very hot weather, rare in Europe. Its clinical characteristics and course in temperate zones are not well known. The objective of this study was to assess the influence of initial fever on prognosis in heatstroke.


METHODS
All patients admitted through the emergency department from 8-13 August 2003 for heatstroke (defined by fever > or = 40 degrees C, with neurologic symptoms in the absence of sepsis) were included in the study. Patients' clinical and laboratory indicators were recorded at admission. Follow-up took place at D28 and 1 year. The influence of fever on survival was assessed with the Kaplan-Meier method.


RESULTS
During the study period, 63 patients, aged 78+/-9 years, were admitted for heatstroke, with a SAPS II (Simplified Acute Physiology Score) of 61+/-24. Core body temperature was 41.4+/-1.2 degrees C. Mortality was 59% at D28 and 67% at 1 year. Prognosis was influenced from admission by temperature, with a higher probability of survival for patients with temperature < 41 degrees C, compared with those whose temperature > or = 41 degrees C (log-rank test: p<0.001).


CONCLUSIONS
Prognosis is poor for classic heatstroke. Rapid temperature reduction, especially when it exceeds > 41 degrees C, must be considered a priority. Fever > or = 41 degrees C at admission for heatstroke is a poor prognostic factor that is simple to identify and may modify treatment strategies in the future.
Marfisi
Aurélia
A
Pôle d'activité d'urgences et réanimation médicale, Groupement hospitalier Edouard Herriot, Hospices civils de Lyon, Université Claude Bernard Lyon 1, F-69437 Lyon Cedex 03, France.
Genty
Annick
A
Ferry
Tristan
T
Martin
Olivier
O
Ducluzeau
Roland
R
Robert
Dominique
D
Argaud
Laurent
L
D000368:Aged; D000369:Aged, 80 and over; D003128:Coma / Q000209:etiology / Q000401:mortality; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000401:mortality*; D005602:France / Q000453:epidemiology; D018883:Heat Stroke / Q000150:complications / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012769:Shock / Q000209:etiology / Q000401:mortality