Diagnostic significance of combined detection of serum indexes in severe heatstroke: a clinical analysis of 70 patients with severe heatstroke

  Objective  The clinical characteristics of patients with severe heatstroke was analyzed to explore the early sensitive clinical indicators for auxiliary diagnosis of heat stroke (HS), in order to intervene these cases as soon as possible.

  Methods  Totally 70 hospitalized patients with severe heatstroke in the Second Affiliated Hospital of Nantong University were studied and their general data and clinical test indexes within 24 hours after admission were collected. According to the severity of heatstroke, they were divided into heat spasm and heat failure group(n = 28), exertional heat stroke(EHS) group(n = 24) and classic heat stroke (CHS) group (n = 18). The differences of clinical indexes of patients in different groups were compared, and the receiver operating characteristic curve (ROC)of heat spasm and heat failure group and HS group was further drawn.

  Results  Among the 70 patients, there were 46 males and 24 females with average age of (65.72 ± 16.64)years old. The maximum temperature of these patients was (39.66 ± 1.08)℃. The hospitalization time was (15.58 ± 14.49) days with dying of 9 cases. There was significant difference of multiple clinical indexes among these three groups (P < 0.05). The body temperature of EHS group and CHS group was higher than that of heat spasm and heat failure group(P < 0.05), but there was no significant difference between EHS group and CHS group(P > 0.05). D-dimer(DD), Procalcitonin(PCT) and Apache Ⅱ in EHS group were higher than those in heat spasm, heat failure and CHS group (P < 0.05). The levels of Platelet (PLT), high-sensitivity C-reactive protein (CRP), blood sodium (Na), blood glucose (Glu) in EHS group were lower than those in heat spasm and heat failure and CHS group (P < 0.05). HbA1C in CHS group was higher than that in heat spasm, heat failure and EHS group(P < 0.05). The receiver operating characteristic curves of individual index in these 3 groups showed that each index could not simultaneously achieve high specificity and sensitivity. The AUC of combined DD, PCT and PLT in series increased to 0.838 (95% CI 0.731 - 0.916), with a sensitivity of 71.43% and a specificity of 85.71%. The diagnostic efficiency of the combined index was higher than any single index.

  Conclusions  The significant decrease of PLT and the increase of PCT and DD may be the early sensitive indexes of HS. The combined detection of these serum indicators can be used as a reference for the early diagnosis and prediction of critical condition of HS.