Prognostic Value And Risk Factors Analysis Of DIC In Patients With Severe Heatstroke A Single-center Retrospective Study

ObjectiveA retrospective analysis of severe heatstroke patients admitted to the General Hospital of Southern Theatre Command in the past 12 years was performed to find out the independent risk factors for predicting in-hospital mortality or disseminated intravascular coagulation(DIC).The disease characteristics of the patients were observed and a prediction model for in-hospital mortality was further constructed according to the independent risk factors.Analyzing the independent risk factors of disseminated intravascular coagulation(DIC)for the purpose of clinical treatment and prognosis.MethodA retrospective study was conducted on patients with severe heatstroke admitted to our hospital from January 1,2008 to December 31,2020.The epidemiological data,laboratory indices within 24 hours of admission,disease severity scores,and outcome were collected.The primary outcome was in-hospital mortality.The independent risk factors were identified by univariate and multivariate logistic regression analysis.The prediction model and the nomogram were constructed based on them.The validity and calibration of the prediction model were evaluated by ROC curve and HosmerLemeshow test,respectively.The secondary outcome was the occurrence of DIC and independent risk factors were also identified by univariate and multivariate analysis.Result210 patients with severe heatstroke were included,of whom 95.2%were male and age of all patients was 30(21-55)years old.73.3%of the patients suffered heatstroke during the period from June to August and 8.6%of the patients had predisposing factors before the onset of disease.18.1%of patients had underlying disease.Totally,19 patients died during hospitalization,so the mortality rate is 9.1%.Compared with the survival group,the non-survival group need more help from vasoactive drugs and mechanical ventilation,with a higher core temperature,heart rate,aspartate aminotransferase,serum creatinine,creatine kinase and D-dimer at admission.Besides,activated partial thromboplastin time,prothrombin time,international standard were significantly prolonged and the level of hemoglobin,fibrinogen,and platelet counts were lower.The incidence of DIC and rhabdomyolysis in the non-survival group were higher than those in the survival group.The higher ISTH,APACHE Ⅱ,SOFA and SIRS scores,lower GCS scores,and longer length of ICU stay were observed in the nonsurvival group(all p<0.05).After univariate and multivariate logistic regression analysis,the results showed that core temperature at admission(OR=1.658),GCS score(OR=0.847)and the occurrence of DIC(OR=7.616)were independent risk factors.Combined with core temperature,DIC and GCS score,the prediction model was constructed as Y=0.506× core temperature+2.030×DIC-0.167×GCS-20.751,and the AUC of ROC curve in predicting in-hospital mortality was 0.897(95%CI 0.848-0.935,p<0.0001),which was no significant difference with that of SOFA score,APACHE II score but better than that of SIRS score.Compared with the patients in the non-DIC group,the DIC group had higher admission heart rate,vasoactive drugs and mechanical ventilation use,serum creatinine,aspartate aminotransferase and creatine kinase,lower hemoglobin,fibrinogen,platelet count,monocytes count.The incidence of rhabdomyolysis in the DIC group was significantly higher than that in the non-DIC group,ISTH score,APACHE Ⅱ score and SOFA score were higher than those in the survival group,the GCS score was lower,and the ICU and total hospital stay were longer(all p<0.05).Univariate and multivariate logistic regression analysis showed that aspartate aminotransferase(OR=1.002),GCS score(OR=0.767)and rhabdomyolysis(OR=3.306)were independent risk factors.Compared with the patients in the non-DIC group,the DIC group had higher heart rate,use of vasoactive drugs and mechanical ventilation,serum creatinine,aspartate aminotransferase,creatine kinase and lower hemoglobin,fibrinogen,platelet count,monocytes count.The incidence of rhabdomyolysis in the DIC group was significantly higher than that in the non-DIC group,ISTH score,APACHE Ⅱ score and SOFA score were higher than those in the non-DIC group,the GCS score was lower,and the ICU and total hospital stay were longer(all p<0.05).Univariate and multivariate logistic regression analysis showed that aspartate aminotransferase(OR=1.002),GCS score(OR=0.767)and rhabdomyolysis(OR=3.306)were independent risk factors for DIC.ConclusionIn the early stage of severe heatstroke,the organ function is seriously damaged.The temperature at admission,GCS score and the existence of DIC are the independent risk factors for in-hospital mortality for severe heatstroke patients.Prediction model has certain prognostic value.Severe heatstroke combined with DIC has a high mortality rate.Severe heatstroke accompanied by liver injury,central system disorder or rhabdomyolysis was associated with increasing risk of DIC.