A newly proposed heatstroke-induced coagulopathy score in patients with heat illness: A multicenter retrospective study in China

IF 1.8 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology Pub Date : 2024-03-01 DOI:10.1016/j.cjtee.2023.08.001

Qing-Wei Lin , Lin-Cui Zhong , Long-Ping He , Qing-Bo Zeng , Wei Zhang , Qing Song , Jing-Chun Song

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引用次数: 0

Abstract

Purpose

In patients with heatstroke, disseminated intravascular coagulation (DIC) is associated with greater risk of in-hospital mortality. However, time-consuming assays or a complex diagnostic system may delay immediate treatment. Therefore, the present study proposes a new heatstroke-induced coagulopathy (HIC) score in patients with heat illness as an early warning indicator for DIC.

Methods

This retrospective study enrolled patients with heat illness in 24 Chinese hospitals from March 2021 to May 2022. Patients under 18 years old, with a congenital clotting disorder or liver disease, or using anticoagulants were excluded. Data were collected on demographic characteristics, routine blood tests, conventional coagulation assays and biochemical indexes. The risk factors related to coagulation function in heatstroke were identified by regression analysis, and used to construct a scoring system for HIC. The data of patients who met the diagnostic criteria for HIC and International Society on Thrombosis and Haemostasis defined-DIC were analyzed. All statistical analyses were performed using SPSS 26.0.

Results

The final analysis included 302 patients with heat illness, of whom 131 (43.4%) suffered from heatstroke, including 7 death (5.3%). Core temperature (OR = 1.681, 95% CI 1.291 − 2.189, p < 0.001), prothrombin time (OR = 1.427, 95% CI 1.175 − 1.733, p < 0.001) and D-dimer (OR = 1.242, 95% CI 1.049 − 1.471, p = 0.012) were independent risk factors for heatstroke, and therefore used to construct an HIC scoring system because of their close relation with abnormal coagulation. A total score ≥ 3 indicated HIC, and HIC scores correlated with the score for International Society of Thrombosis and Hemostasis -DIC (r = 0.8848, p < 0.001). The incidence of HIC (27.5%) was higher than that of DIC (11.2%) in all of 131 heatstroke patients. Meanwhile, the mortality rate of HIC (19.4%) was lower than that of DIC (46.7%). When HIC developed into DIC, parameters of coagulation dysfunction changed significantly: platelet count decreased, D-dimer level rose, and prothrombin time and activated partial thromboplastin time prolonged (p < 0.05).

Conclusions

The newly proposed HIC score may provide a valuable tool for early detection of HIC and prompt initiation of treatment.

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新提出的热病患者中暑诱发凝血病评分标准：中国多中心回顾性研究

目的在中暑患者中，弥散性血管内凝血（DIC）与较高的院内死亡风险相关。然而，耗时的检测或复杂的诊断系统可能会延误及时治疗。因此，本研究提出了一种新的热病患者中暑诱发凝血病（HIC）评分，作为DIC的早期预警指标。方法这项回顾性研究招募了2021年3月至2022年5月期间在中国24家医院就诊的热病患者。研究排除了未满18岁、患有先天性凝血功能障碍或肝病、使用抗凝药物的患者。收集的数据包括人口统计学特征、血常规检查、常规凝血检测和生化指标。通过回归分析确定了与中暑凝血功能相关的危险因素，并利用这些因素构建了 HIC 评分系统。对符合 HIC 诊断标准和国际血栓与止血学会定义-DIC 的患者数据进行了分析。所有统计分析均使用 SPSS 26.0 进行。结果最终分析包括 302 名热病患者，其中 131 人（43.4%）中暑，包括 7 人死亡（5.3%）。核心温度（OR = 1.681，95% CI 1.291 - 2.189，p <0.001）、凝血酶原时间（OR = 1.427，95% CI 1.175 - 1.733，p <0.001）和 D-二聚体（OR = 1.242，95% CI 1.049 - 1.471，p = 0.012）是中暑的独立危险因素，因此用于构建 HIC 评分系统，因为它们与凝血异常密切相关。总分≥3分表示HIC，HIC得分与国际血栓与止血学会-DIC得分相关（r = 0.8848，p <0.001）。在所有 131 名中暑患者中，HIC 的发生率（27.5%）高于 DIC 的发生率（11.2%）。同时，HIC 的死亡率（19.4%）低于 DIC 的死亡率（46.7%）。当 HIC 发展为 DIC 时，凝血功能障碍的参数发生了显著变化：血小板计数减少，D-二聚体水平升高，凝血酶原时间和活化部分凝血活酶时间延长（p < 0.05）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chinese Journal of Traumatology ORTHOPEDICS-

CiteScore

3.80

自引率

4.80%

发文量

1707

审稿时长

28 weeks

期刊介绍： Chinese Journal of Traumatology (CJT, ISSN 1008-1275) was launched in 1998 and is a peer-reviewed English journal authorized by Chinese Association of Trauma, Chinese Medical Association. It is multidisciplinary and designed to provide the most current and relevant information for both the clinical and basic research in the field of traumatic medicine. CJT primarily publishes expert forums, original papers, case reports and so on. Topics cover trauma system and management, surgical procedures, acute care, rehabilitation, post-traumatic complications, translational medicine, traffic medicine and other related areas. The journal especially emphasizes clinical application, technique, surgical video, guideline, recommendations for more effective surgical approaches.