Changes in coagulation function in patients with exertional heat illness at different core temperatures:a multicenter retrospective study
10.11855/j.issn.0577-7402.1244.2024.0730
- VernacularTitle:不同核心体温的劳力性中暑患者凝血功能变化特征:一项多中心回顾性研究
- Author:
Qing-Wei LIN
1
;
Jing-Chun SONG
;
Qing SONG
;
Yan GAO
;
Hai-Ling LI
;
Wei ZHANG
;
Yu-Xiang ZHANG
;
Qing-Hua LI
Author Information
1. 解放军联勤保障部队第908医院重症医学科,江西南昌 330002
- Collective Name:Expert Group of Heatstroke Prevention and Treatment of Chinese PLA
- Publication Type:Journal Article
- Keywords:
exertional heat illness;
core temperature;
coagulation function;
D-dimer;
prothrombin time
- From:
Medical Journal of Chinese People's Liberation Army
2024;49(12):1372-1378
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the characteristics of coagulation function changes in patients with exertional heat illness(EHI)at different core temperatures(Tc).Methods A retrospective analysis was conducted on the clinical data of 346 EHI patients admitted to the emergency or intensive care units of 24 military hospitals from March 2021 to November 2022.According to the Tc at admission,patients were divided into 4 groups:Tc<39℃group(n=223),39℃≤Tc<40℃group(n=60),40℃≤Tc<41℃group(n=35),41℃≤Tc<42℃group(n=17),and Tc≥42℃group(n=11).Based on the occurrence of heat stroke,the 346 EHI patients were further divided into heat stroke group(n=63)and non-heat stroke group(n=283).Basic information,complete blood count,coagulation function,liver and kidney function,and other laboratory indicators of the patients in each group were collected and statistically analyzed.Multifactorial logistic regression analysis was used to identify independent risk factors for the development of heat stroke in EHI patients.The diagnostic value of prothrombin time(PT),D-dimer,and platelet count for EHI patients developing heat stroke was assessed using the receiver operating characteristic(ROC)curve.Results When Tc exceeded 39℃,D-dimer levels in EHI patients increased significantly and further elevated with rising Tc(P<0.05).When Tc exceeded 40℃,platelet count and fibrinogen levels decreased,and PT was prolonged(P<0.05).When Tc exceeded 41℃,activated partial thromboplastin time(APTT)was significantly prolonged,and platelet count and fibrinogen level decreased(P<0.05).Multivariate logistics regression analysis showed that PT(OR=1.120,95%CI 1.015-1.236),D-dimer(OR=1.322,95%CI 1.129-1.549),and platelet count(OR=0.991,95%CI 0.985-0.997)were independent risk factors for heat stroke(P<0.05).The area under the ROC curve(AUC)for D-dimer in diagnosing heat stroke was 0.796(95%CI 0.732-0.860,P<0.001)with sensitivity and specificity of 69%and 80%,respectively,when D-dimer was greater than 0.9 μg/ml.The AUC for PT in diagnosing heat stroke was 0.708(95%CI 0.628-0.788,P<0.001),with sensitivity and specificity of 42%and 97%,respectively,when PT was greater than 16.4 s.The AUC for platelet count in diagnosing heat stroke was 0.724(95%CI 0.642-0.807,P<0.001),with the sensitivity and specificity of 52%and 94%,respectively,when the platelet count was less than 140×109/L.Conclusions The degree of Tc elevation in EHI patients is positively correlated with the severity of coagulation dysfunction.Prolonged PT,increased D-dimer level,and decreased platelet count are independent risk factors for the development of exertional heat stroke in EHI patients.
