nach oben

Erschienen in:

01.02.2010 | Original

Prognostic factors in non-exertional heatstroke

verfasst von: Pierre Hausfater, Bruno Megarbane, Sandrine Dautheville, Anabella Patzak, Marc Andronikof, Aline Santin, Stéphanie André, Ludovic Korchia, Nabila Terbaoui, Gérald Kierzek, Benoît Doumenc, Christophe Leroy, Bruno Riou

Erschienen in: Intensive Care Medicine | Ausgabe 2/2010

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To identify the prognostic factors associated with mortality in heat-related illness.

Methods

Multi-center observational cohort-study in 16 emergency departments (ED) belonging to the teaching hospital network of the Paris area. The cohort comprised all patients admitted to one of the EDs during the August 2003 heat wave in Paris and having a core temperature >38.5°C. Baseline clinical and biological data in ED, patient’s course and 1-year survival rate were recorded. Potential prognostic factors associated with death were assessed by Cox proportional-hazards analysis.

Results

A total of 1,456 patients were included. Mean age was 79 ± 19 years. Critically ill conditions were noted in 391 patients (27%), but only 72 (5%) were admitted into an intensive care unit. The survival rate was 57% at 1 year as compared to an expected 90% (P < 0.001). Nine independent prognostic factors were identified: previous treatment with diuretics, living in an institution, age >80 years, cardiac disease, cancer, core temperature >40°C, systolic arterial pressure <100 mmHg, Glasgow coma scale <12 and transportation to hospital by ambulance. We defined three risk groups: low, intermediate and high risk, with a 1-year survival rate of 85, 61 and 18%, respectively.

Conclusions

We observed a low survival rate and developed a risk score based on easily obtained variables that may be useful to clinicians managing casualties from future heat waves.

Nur mit Berechtigung zugänglich

Bouchama A, Knochel JP. (2002) Heatstroke. N Engl J Med 346:1978–1988

Jones TS, Liang AP, Kilbourne EM, Griffin MR, Patriarca PA, Wassilak SG, Mullan RJ, Herrick RF, Donnell HD Jr, Choi K, Thacker SB (1982) Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, MO. JAMA 247:3327–3331CrossRefPubMed

Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL (1996) Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 335:84–90CrossRefPubMed

Rooney C, Mc Michael AJ, Kovats RS, Coleman P (1998) Excess mortality in England and Wales and in Greater London, during the 1996 heatwave. J Epidemiol Community Health 52:482–486CrossRefPubMed

Patz JA, Campbell-Lendrum D, Holloway T, Foley JA (2005) Impact of regional climate change on human health. Nature 438:310–317CrossRefPubMed

Dhainaut JF, Claessens YE, Ginsburg C, Riou B (2004) Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments. Crit Care 8:1–2CrossRefPubMed

Al Bubrek D, Bakon S, Moran DS, Faibel M, Epstein Y (1997) Heat stroke-induced cerebellar atrophy: clinical course, CT and MRI findings. Neuradiology 39:195–197CrossRef

Fouillet A, Rey G, Laurent F, Pavillon G, Bellec S, Guihenneuc-Jouyaux C, Clavel J, Jougla E, Hémon D (2006) Excess mortality related to the August 2003 heat wave in France. Int Arch Occup Environ Health 80:16–24CrossRefPubMed

Argaud L, Ferry T, Le QH, Marfisi A, Ciorba D, Achache P, Ducluzeau R, Robert D (2007) Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France. Arch Intern Med 167:2177–2183CrossRefPubMed

10.

O’Neill MS, Zanobetti A, Schwartz J (2003) Modifiers of the temperature and mortality association in seven US cities. Am J Epidemiol 157:1074–1082CrossRefPubMed

11.

Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A, Anderson HR, Bisanti L, D’Ippoliti D, Danova J, Forsberg B, Medina S, Paldy A, Rabczenko D, Schindler C, Michelozzi P (2008) Heat effects on mortality in 15 European cities. Epidemiology 19:711–719CrossRefPubMed

12.

Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B (2007) Prognostic factors in heat wave-related deaths. A meta-analysis. Arch Intern Med 167:2170–2176CrossRefPubMed

13.

Misset B, de Jonghe B, Bastuji-Garin S, Gattolliat O, Boughrara E, Annane D, Hausfater P, Garrouste-Orgeas M, Carlet J (2006) Mortality of patients with heatstroke admitted to intensive care units during the 2003 heat wave in France: a National-multicenter risk-factor study. Crit Care Med 34:1087–1092CrossRefPubMed

14.

Pease S, Bouadma L, Kermarrec N, Schortgen N, Régnier B, Wolff M (2009) Early organ dysfunction course, cooling time and outcome in classic heatstroke. Intensive Care Med 35:1454–1458CrossRefPubMed

15.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919PubMed

16.

Rivera R, Antognini JF (2009) Perioperative drug therapy in elderly patients. Anesthesiology 110:1176–1181CrossRefPubMed

17.

Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A (2008) Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome: propensity-adjusted analyses. Anesthesiology 108:979–987CrossRefPubMed

18.

Molinaro AM, Simon R, Pfeiffer RM (2005) Prediction error estimation: a comparison of resampling method. Bioinformatics 21:3301–3307CrossRefPubMed

19.

Efron B, Tibshirani RJ (1993) An introduction to the bootstrap. Chapman & Hall, New York

20.

Dematte JE, O’Mara K, Buescher J, Whitney CG, Forsythe S, McNamee T, Adiga RB, Ndukwu IM (1998) Near-fatal Heat stroke during the 1995 heat wave in Chicago. Ann Intern Med 129:173–181PubMed

21.

Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B (2007) Serum procalcitonin measurements as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care 11:R60CrossRefPubMed

22.

Hausfater P, Riou B (2007) Coup de chaleur Encycl Med Chir Urgences 24-116-A20. Elsevier, Paris

23.

Huisse MG, Pease S, Hurtado-Nedelec M, Arnaud B, Malaquin C, Wolff M, Gougerot-Pocidalo MA, Kermarrec N, Bezeaud A, Guillin MC, Paoletti X, Chollet-Martin S (2008) Leukocyte activation: the link between inflammation and coagulation during heatstroke. A study of patients during the 2003 heat wave in Paris. Crit Care Med 36:2455–2456CrossRef

24.

Claessens YE, Taupin P, Kierzek G, Pourriat JL, Baud M, Ginsburg C, Jais JP, Jougla E, Riou B, Dhainaut JF, Landais P (2006) How emergency departments might alert for prehospital heat-related excess mortality? Crit Care 10:R156CrossRefPubMed

25.

Kaarlola A, Tallgren M, Pettila V (2006) Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 34:2120–2126CrossRefPubMed

Titel: Prognostic factors in non-exertional heatstroke
verfasst von: Pierre Hausfater
Bruno Megarbane
Sandrine Dautheville
Anabella Patzak
Marc Andronikof
Aline Santin
Stéphanie André
Ludovic Korchia
Nabila Terbaoui
Gérald Kierzek
Benoît Doumenc
Christophe Leroy
Bruno Riou
Publikationsdatum: 01.02.2010
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 2/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1694-y

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Prognostic factors in non-exertional heatstroke