Risk factors and predictive models for sequelae of heat stroke primarily involving cerebellar dysfunction

ABSTRACT

The occurrence of sequelae is common after heatstroke. There is a lack of risk prediction data regarding the prevalence of sequelae. This study aims to develop a predictive model for the sequelae after heatstroke, including cerebellar dysfunction. Heatstroke patients admitted to our hospital in the past 8 years were retrospectively enrolled. Regression analyses were conducted to identify risk factors associated with sequelae and cerebellar dysfunction. A prediction model for post-heatstroke sequelae was developed and internally and externally validated. Twenty-three percent of the patients experienced sequelae, with cerebellar dysfunction accounting for 51.7%. Patients with sequelae had longer duration of hyperthermia and coma, lower Glasgow Coma Scales scores, elevated core temperature, increased incidence of multiple organ dysfunction upon admission, and a worse prognosis compared to non-sequelae patients. Patients with cerebellar injury exhibited impaired balance, and a Sepsis-related Organ Failure Assessment (SOFA) score > 5 is an independent risk factor. The prediction system included advanced age, coma, and an APACHE-II score > 10 upon admission, predicting sensitivity = 0.8966, specificity = 0.8925, and AUC of ROC curve = 0.941 (95% CI: 0.884 ~ 0.976). The C-index in the internal verification was 0.942 (95% CI: 0.847 ~ 0.981) and the AUC in the external verification was 0.816 (95% CI: 0.699 ~ 0.902). The prediction system included advanced age, coma, and higher APACHE-II scores as variables, indicating a significant prevalence of sequelae. Higher SOFA scores were associated with the increased occurrence of cerebellar dysfunction and balance impairment. The prediction system could better predict sequelae after heatstroke.

KEYWORDS:

• Heatstroke
• sequelae
• model
• cerebellar injury
• prediction

Acknowledgements

I would like to express my sincere gratitude to Prof. Lei Su and Rong-hao Yu for their invaluable guidance throughout the course of this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions statement

XXN: designing, data acquisition, drafting of the original draft and revising; GCX: designing, statistical analysis, modeling and validation; YQG: data acquisition and analysis; XJX: methodology, conceptualization and analysis; JW: designing and investigation; ZFL: funding acquisition, conception and designing, revising and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Data availability statement

Data available on request from authors.

Ethical approval statement

This study was approved by the Ethics Committee of the General Hospital of Southern Theater Command of PLA, Guangzhou, Guangdong Province, China (approval no. NZLLKZ2022003) and were conducted in accordance with the 1964 Helsinki Declaration and its later amendments. This retrospective study did not result in any adverse effects on human subjects. The informed verbal consent was obtained from all individual participants in the study due to objective circumstances, such as the patient’s cognitive impairment, inability to sign, and inability to meet the patients or guardians in person. The informed verbal consent was obtained by telephone follow-up to explain the process and purpose of the study and to obtain consent, which was recorded. Additionally, measures were taken to protect the patient such as concealing patient identity information and complete anonymization.

Additional information

Funding

This work was supported by grants from the National Natural Science Foundation of China [No. 82072143] and Natural Science Foundation of Guangdong Province of China [No. 2021A1515010170].