Establishment Of Exertional Heat Stroke Score System And Related Software Development

Background: Heat stroke (HS) is a life-threatening illness characterized by core body temperatures above 40℃ coupled with central nervous system (CNS)dysfunction,including delirium,convulsions,and/or coma.Two forms of HS have been recognized: classic heat stroke (CHS) and exertional heat stroke (EHS).Which the EHS onset is dangerous,and it with rapid progress and high clinical mortality rate. Therefore,early assessment the severity of EHS, early treatment and prognostic judgment for this disease is essential to reduce the mortality of EHS patients. Up to now,there is a lack of scoring system which specific for EHS in clinical,and often with APACHE Ⅱ score to assess the severity of this disease.However, the common causes of death in EHS patients are DIC caused by coagulation dysfunction and AKI caused by rhabdomyolysis, and the APACHE Ⅱ score ignored the effects of these two indicators.The scoring software,which corresponding to the Exertional Heat Stroke Score (EHSS),can help the clinicians to achieve a timely and comprehensive control of EHS patients’ conditions,has a high clinical value.Objective: Establishing a scoring system EHSS which specific for EHS,and then compared with APACHE Ⅱ and SOFA scores,to verify its effectiveness of evaluation on the prognosis of EHS patients;Developing a scoring software that corresponds to EHSS simultaneously.Methods: In the first part of our study, we have collected 170 cases of EHS patients’data from 52 hospitals in China,including PLA General Hospital,took place from 2005 to 2016. In this part, 90 cases were randomly selected as the objects of research,69 patients (76.7%) survived and 21 (23.3%) died.Based on the clinical experience,literature review and expert consensus of HS, we initially screened 42 physiological parameters that could reflect the injuried degree of each system in the body as the alternative parameters to establish EH SS.Uni variate statistical analysis is performed in this process, parameters that have the statistical significance will be selected as the preliminary screening parameters of EHSS,then calculate the areas under the receiver operating characteristic curve (AUC) of above parameters. Taking the AUC>0.7 parameters as the parameters of EHSS.According to the assignment method of MODS score, the value of each parameter is divided into 5 intervals, given 0-4 points.In the second part of our study, we have collected 170 cases of EHS patients’ data from 52 hospitals in China,including PLA General Hospital,took place from 2005 to 2016. In this part, 80 cases were randomly selected as the objects of research,62 patients(77.5%) survived and 18 (22.5%) died. After verifying the homology with the first part of EHS patients, the APACHE Ⅱ and SOFA scores and EHSS of the 80 EHS patients were calculated respectively. Comparing the size of AUC of the three scoring systems to verify the efficacy of EHSS in evaluating the prognosis of EHS patients.At the same time,the mortality rates of EHS patients with different intervals of EHSS are compared as well.Using a variety of computer-related hardware and software technology, and developing the software of EHSS that corresponds to EHSS.Results: In the first part of our study, the results of univariate statistical analysis showed that T, RR,GCS, PH, Sa02, Lac, WBC,PLT, TnI, LDH, ALT,AST, TBIL,DBIL,Cr,BUN, CK, TT, PT, APTT, Fib, Ca2+ and gastrointestinal AGI grade in total 23 parameters are as the initial parameters of establishment of EHSS. We calculated the AUC of the other 22 parameters except for the gastrointestinal AGI grade, combined with previous reports, the 12 parameters of T, GCS, PH, Lac, PLT, PT, Fib, TnI, AST,TBIL, Cr and gastrointestinal AGI grade were determined as parameters of EHSS finally, which are consistent with the characteristics of multiple organ injury of EHS,and the coagulation function had the greatest effect on prognosis, followed by liver function. After the the interval division and assignment for each parameter, the total score of EHSS is 47 points. At this point, EHSS is completed.In the second part of our study, we found that the AUC of EHSS and APACHE Ⅱ and SOFA scores were 0.97 (0.925-1) and 0.885 (0.809-0.961) and 0.886(0.795-0.946)respectively. The EHSS was superior to APACHE Ⅱ and SOFA scores in evaluating the prognosis of EHS patients, and the diagnostic effect was good. When EHSS > 22 points,the risk of death in EHS patients began to increase. With the increase in EHSS scores,EHS patients’ mortality is also rising. With the help of computer technology, our study successfully developed the software of EHSS with the function of automatic calculation of EHSS score and storage of EHS patients’ information,and most importantly,we have obtained the software copyrights.Conclusions:(1)In our study, the EHSS which composed of 12 parameters including T,GCS, PH, Lac, PLT, PT, Fib, TnI, AST, TBIL, Cr and gastrointestinal AGI grade has been established,and the selected parameters are reasonable.(2)The EHSS in this study was superior to APACHE Ⅱ and SOFA scores in evaluating the prognosis of EHS patients, and the diagnostic effect was good. When EHSS > 22 points, the risk of death in EHS patients began to increase. With the increase in EHSS scores, EHS patients mortality is also rising.(3)EHSS software which could calculate the score of EHSS and store EHS patients’ information has been successfully developed,and the future of clinical application value is high.