Diagnostic accuracy of thermal, hydration, and heart rate assessments in discriminating positive acute kidney injury risk following physical work in the heat.
Christopher L Chapman, Blair D Johnson, David P Hostler, Zachary J Schlader
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引用次数: 0
Abstract
Occupational heat stress increases the risk of acute kidney injury (AKI). This study presents a secondary analysis to generate novel hypotheses for future studies by investigating the diagnostic accuracy of thermal, hydration, and heart rate assessments in discriminating positive AKI risk following physical work in the heat in unacclimatized individuals. Unacclimatized participants (n = 13, 3 women, age: ∼23 years) completed four trials involving 2 h of exercise in a 39.7 ± 0.6 °C, 32 ± 3% relative humidity environment that differed by experimental manipulation of hyperthermia (i.e., cooling intervention) and dehydration (i.e., water drinking). Diagnostic accuracy was assessed via receiver operating characteristic curve analysis. Positive AKI risk was identified when the product of concentrations insulin-like growth factor binding protein 7 and tissue inhibitor of metalloproteinase-2 [IGFBP7∙TIMP-2] exceeded 0.3 (ng∙mL-1)2∙1000-1. Peak absolute core temperature had the acceptable discriminatory ability (AUC = 0.71, p = 0.009), but a relatively large variance (AUC 95% CI: 0.57-0.86). Mean body temperature, urine specific gravity, urine osmolality, peak heart rate, and the peak percent of both maximum heart rate and heart rate reserve had poor discrimination (AUC = 0.66-0.69, p ≤ 0.051). Mean skin temperature, percent change in body mass and plasma volume, and serum sodium and osmolality had no discrimination (p ≥ 0.072). A peak increase in mean skin temperature of >4.7 °C had a positive likelihood ratio of 11.0 which suggests clinical significance. These data suggest that the absolute value of peak core temperature and the increase in mean skin temperature may be valuable to pursue in future studies as a biomarker for AKI risk in unacclimatized workers.
期刊介绍:
The Journal of Occupational and Environmental Hygiene ( JOEH ) is a joint publication of the American Industrial Hygiene Association (AIHA®) and ACGIH®. The JOEH is a peer-reviewed journal devoted to enhancing the knowledge and practice of occupational and environmental hygiene and safety by widely disseminating research articles and applied studies of the highest quality.
The JOEH provides a written medium for the communication of ideas, methods, processes, and research in core and emerging areas of occupational and environmental hygiene. Core domains include, but are not limited to: exposure assessment, control strategies, ergonomics, and risk analysis. Emerging domains include, but are not limited to: sensor technology, emergency preparedness and response, changing workforce, and management and analysis of "big" data.