Severe acute liver injury in patients with exertional heat stroke associated with poor short-term prognosis

doi:10.5847/wjem.j.1920-8642.2022.047

Abstract

Chen Li, Hai-bin Su, Hui Li, Xin Li, Hong-min Wang, Qing Song, Jin-hua Hu. Severe acute liver injury in patients with exertional heat stroke associated with poor short-term prognosis[J]. World Journal of Emergency Medicine, 2022, 13(2): 124-129.

Figures/Tables 2

Table 1

Clinical characteristic in the SALI and non-SALI groups at admission

Variables	All (n=52)	SALI group (n=7)	Non-SALI group (n=45)	P-value
Age (years)	21.0 (19.0-24.0)	23.0 (19.0-30.0)	21.0 (19.0-23.0)	0.429
Transferred patients	21 (40.4)	5 (71.4)	16 (35.6)	0.166
Temperature (℃)	36.8 (36.5-37.3)	36.7 (36.5-37.1)	36.6 (36.5-37.3)	0.694
Liver injury	40 (76.9)	7 (100.0)	33 (73.3)	0.282
AKI	33 (63.5)	6 (85.7)	27 (60.0)	0.372
Rhabdomyolysis	25 (48.1)	7 (100.0)	18 (40.0)	0.011
CNS disorder	12 (23.1)	5 (71.4)	7 (15.6)	0.005
BIs	8 (15.4)	2 (28.6)	6 (13.3)	0.634
Respiratory failure	6 (11.5)	4 (57.1)	2 (4.4)	0.002
DIC	5 (9.6)	4 (57.1)	1 (2.2)	0.001
Myocardial injury	5 (9.6)	2 (28.6)	3 (6.7)	0.129
SOFA scores	2.5 (1.0-7.0)	15.0 (9.0-17.0)	2.0 (1.0-3.0)	< 0.001
MODS (%)	14 (26.9)	6 (85.7)	8 (17.8)	0.001
GCS scores	15.0 (13.3-15.0)	4.0 (3.0-15.0)	15.0 (15.0-15.0)	< 0.001
ALT (U/L)	37.5 (18.2-256.6)	2,839.8 (71.7-4,688.2)	35.0 (16.4-99.2)	< 0.001
AST (U/L)	54.3 (27.1-210.9)	1,527.9 (77.2-2,714.7)	48.4 (22.9-114.4)	0.002
ALB (g/L)	40.4 ± 5.5	36.5 ± 4.0	41.0 ± 5.5	0.046
TBIL (μmol/L)	17.6 (11.6-32.6)	109.6 (34.8-189.8)	15.7 (11.4-28.2)	0.002
DBIL (μmol/L)	6.2 (4.3-11.2)	60.9 (20.2-99.9)	5.8 (4.0-10.6)	0.001
ALP (U/L)	68.8 ± 22.6	89.5 ± 23.8	65.6 ± 20.9	0.008
Cr (μmol/L)	110.7 (86.8-150.0)	253.0 (145.6-351.7)	101.7 (86.8-143.1)	0.011
cTnI (ng/mL)	28.0 (8.3-71.3)	171.0 (26.0-231.0)	24.0 (7.0-60.0)	0.013
Mb (ng/mL)	214.7 (46.6-1,060.0)	2,136.0 (1,005.0-8,037.0)	109.9 (41.1-563.0)	< 0.001
CK (U/L)	561.3 (261.8-2,473.6)	2,655.3 (1,011.0-24,982.0)	470.2 (226.5-1,513.0)	0.011
WBC (×10⁹/L)	9.1 (6.6-12.0)	10.2 (5.3-11.5)	9.1 (6.7-12.5)	1.000
Neutrophil (%)	81.5 (67.0-86.8)	83.6 (79.0-93.0)	81.0 (65.0-86.5)	0.167
HGB (g/L)	138.5 (124.8-150.0)	118.0 (81.0-139.0)	141.0 (128.5-151.5)	0.019
PLT (×10⁹/L)	165.6 ± 70.5	80.0 ± 64.4	178.8 ± 62.1	< 0.001
PT (s)	16.5 (15.0-19.5)	26.2 (23.9-49.3)	15.8 (14.8-17.8)	< 0.001
INR	1.3 (1.2-1.6)	2.8 (1.9-5.3)	1.3 (1.2-1.5)	< 0.001

Table 1

Figure 1.

References 33

1	Becker JA, Stewart LK. Heat-related illness. Am Fam Physician. 2011; 83(11):1325-30.
2	Sawka MN, Leon LR, Montain SJ, Sonna LA. Integrated physiological mechanisms of exercise performance, adaptation, and maladaptation to heat stress. Compr Physiol. 2011; 1(4):1883-928.
3	Alele FO, Malau-Aduli BS, Malau-Aduli AEO, Crowe MJ. Epidemiology of exertional heat illness in the military: a systematic review of observational studies. Int J Environ Res Public Heal. 2020; 17(19):7037.
4	Filep EM, Murata Y, Endres BD, Kim G, Stearns RL, Casa DJ. Exertional heat stroke, modality cooling rate, and survival outcomes: a systematic review. Medicina (Kaunas). 2020; 56(11):589.
5	Update: Heat illness, active component, U.S. Armed Forces, 2020. MSMR. 2021; 28(4):10-5.
6	Ward MD, King MA, Gabrial C, Kenefick RW, Leon LR. Biochemical recovery from exertional heat stroke follows a 16-day time course. PLoS One. 2020; 15(3):e0229616. doi: 10.1371/journal.pone.0229616
7	Ribeiro F, Bibi M, Pereira M, Ferreira S, Pessegueiro H, Araújo R. Severe acute liver injury related to heat stroke. Eur J Case Rep Intern Med. 2020; 7(2):001382.
8	Davis BC, Tillman H, Chung RT, Stravitz RT, Reddy R, Fontana RJ, et al. Heat stroke leading to acute liver injury & failure: a case series from the Acute Liver Failure Study Group. Liver Int. 2017; 37(4):509-13. doi: 10.1111/liv.2017.37.issue-4
9	European Association for the Study of the Liver. Clinical practice guidelines panel. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017; 66(5):1047-81. doi: 10.1016/j.jhep.2016.12.003
10	Koch DG, Speiser JL, Durkalski V, Fontana RJ, Davern T, McGuire B, et al. The natural history of severe acute liver injury. Am J Gastroenterol. 2017; 112(9):1389-96. doi: 10.1038/ajg.2017.98
11	Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, et al. National athletic trainers' association position statement: exertional heat illnesses.[J] Athl Train. 2015; 50(9):986-1000.
12	Belval LN, Casa DJ, Adams WM, Chiampas GT, Holschen JC, Hosokawa Y, et al. Consensus statement- prehospital care of exertional heat stroke. Prehosp Emerg Care. 2018; 22(3):392-7. doi: 10.1080/10903127.2017.1392666 pmid: 29336710
13	Antonelli M, Moreno R, Vincent JL, Sprung CL, Mendoça A, Passariello M, et al. Application of SOFA score to trauma patients. Sequential Organ Failure Assessment. Intensive Care Med. 1999; 25(4):389-94.
14	Cole E, Gillespie S, Vulliamy P, Brohi K, Organ Dysfunction in Trauma (ORDIT) study collaborators. Multiple organ dysfunction after trauma. Br J Surg. 2020; 107(4):402-12.
15	Riordan SM, Williams R. Treatment of hepatic encephalopathy. N Engl J Med. 1997; 337(7):473-9. doi: 10.1056/NEJM199708143370707
16	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4):c179-84.
17	Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M, Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001; 86(5):1327-30.
18	Nance JR, Mammen AL. Diagnostic evaluation of rhabdomyolysis. Muscle Nerve. 2015; 51(6):793-810. doi: 10.1002/mus.v51.6
19	Leon LR, Helwig BG. Heat stroke: role of the systemic inflammatory response. J Appl Physiol (1985). 2010; 109(6):1980-8. doi: 10.1152/japplphysiol.00301.2010
20	Ichai P, Laurent-Bellue A, Camus C, Moreau D, Boutonnet M, Saliba F, et al. Liver transplantation in patients with liver failure related to exertional heatstroke. J Hepatol. 2019; 70(3):431-9. doi: 10.1016/j.jhep.2018.11.024
21	Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002; 346(25):1978-88. doi: 10.1056/NEJMra011089
22	Wijerathne BT, Pilapitiya SD, Vijitharan V, Farah MM, Wimalasooriya YV, Siribaddana SH. Exertional heat stroke in a young military trainee: is it preventable? Mil Med Res. 2016; 3:8. doi: 10.1186/s40779-016-0078-1 pmid: 27042327
23	Jin Q, Chen EZ, Jiang J, Lu YM. Acute hepatic failure as a leading manifestation in exertional heat stroke. Case Rep Crit Care. 2012; 2012:295867. doi: 10.1155/2012/295867 pmid: 24826335
24	Abriat A, Brosset C, Brégigeon M, Sagui E. Report of 182 cases of exertional heatstroke in the French armed forces. Mil Med. 2014; 179(3):309-14. doi: 10.7205/MILMED-D-13-00315
25	Varghese GM, John G, Thomas K, Abraham OC, Mathai D. Predictors of multi-organ dysfunction in heatstroke. Emerg Med J. 2005; 22(3):185-7. pmid: 15735266
26	Tong HS, Liu YS, Wen Q, Tang YQ, Yuan FF, Su L. Serum procalcitonin predicting mortality in exertional heatstroke. Emerg Med J. 2012; 29(2):113-7.
27	Pryor RR, Bennett BL, OʼConnor FG, Young JMJ, Asplund CA. Medical evaluation for exposure extremes: heat. Clin J Sport Med. 2015; 25(5):437-42. doi: 10.1097/JSM.0000000000000248
28	Geng Y, Ma Q, Liu YN, Peng N, Yuan FF, Li XG, et al. Heatstroke induces liver injury via IL-1β and HMGB1-induced pyroptosis. J Hepatol. 2015; 63(3):622-33. doi: 10.1016/j.jhep.2015.04.010 pmid: 25931416
29	Yang MM, Li Z, Zhao Y, Zhou FH, Zhang Y, Gao JL, et al. Outcome and risk factors associated with extent of central nervous system injury due to exertional heat stroke. Medicine (Baltimore). 2017; 96(44):e8417. doi: 10.1097/MD.0000000000008417
30	Zhong L, Ji JJ, Wang CL, Liu ZF. Clinical characteristics and risk factors of male exertional heatstroke in patients with myocardial injury: an over 10-year retrospective cohort study. Int J Hyperthermia. 2021; 38(1):970-5. doi: 10.1080/02656736.2021.1941312
31	Donham BP, Frankfurt SB, Cartier RA, O'Hara SM, Sieg VC. Low incidence of death and renal failure in United States military service members hospitalized with exertional heat stroke: a retrospective cohort study. Mil Med. 2020; 185(Suppl 1):362-7. doi: 10.1093/milmed/usz214
32	Figiel W, Morawski M, Grąt M, Kornasiewicz O, Niewiński G, Raszeja-Wyszomirska J, et al. Fulminant liver failure following a marathon: five case reports and review of literature. World J Clin Cases. 2019; 7(12):1467-74. doi: 10.12998/wjcc.v7.i12.1467
33	Epstein Y, Druyan A, Heled Y. Heat injury prevention--a military perspective. J Strength Cond Res. 2012; 26(Suppl 2):S82-6. doi: 10.1519/JSC.0b013e31825cec4a

Severe acute liver injury in patients with exertional heat stroke associated with poor short-term prognosis

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 2

References 33

Related Articles 0

Recommended Articles

Comments