Clinical characteristics and risk factors of male exertional heatstroke in patients with myocardial injury: an over 10-year retrospective cohort study

Figures & data

Figure 1. Flowchart of all excluded and included patients.

Table 1. Baseline characteristics of clinical and laboratory findings in MI group and Non-MI group.

	Total (N = 162)	Non-MI group (N = 75)	MI group (N = 87)	p value
APACHII score, median (IQR)	12.0 (8.0–17.0)	8.0 (7.0–11.0)	16.0 (13.0–22.0)	<.001
SOFA score, median (IQR)	4.0 (2.0–6.5)	2.0 (2.0–4.0)	6.0 (3.0–9.0)	<.001
GCS score, median (IQR)	12.0 (6.5–14.0)	13.5 (12.0–14.0)	8.0 (5.0–12.0)	<.001
Age (years), median (IQR)	21.0 (19.0–27.0)	20.0 (19.0–24.0)	23.0 (19.0–31.0)	.005
WBC (1 × 10^9/L), median (IQR)	11.4 (8.6–14.7)	10.8 (8.1–14.6)	11.7 (9.2–14.7)	.206
Neutrophil (1 × 10^9/L), median (IQR)	9.0 (6.6–12.4)	7.7 (5.5–12.1)	9.6 (7.4–13.1)	.032
Lymphocyte (1 × 10^9/L), median (IQR)	1.1 (0.6–1.9)	1.5 (0.8–2.1)	0.7 (0.4–1.5)	<.001
Monocytes (1 × 10^9/L), median (IQR)	0.7 (0.4–1.0)	0.6 (0.4–0.9)	0.7 (0.4–1.0)	.127
Platelets (1 × 10^9/L), median (IQR)	151.0 (75.3–204.8)	180.5 (144.0–225.3)	90.0 (49.8–166.3)	<.001
Mean platelet volume (%)	10.8 (10.1–11.5)	10.7 (10.1–11.5)	10.9 (10.2–11.7)	.456
Platelet distribution width (%)	12.5 (11.5–13.8)	12.4 (11.5–13.4)	12.5 (11.5–14.2)	.376
TBIL (µmol/L), median (IQR)	16.5 (10.2–35.0)	14.6 (9.7–24.9)	20.5 (11.1–44.8)	.024
ALT (U/L), median (IQR)	37.0 (21.0–263.8)	25.5 (15.8–115.0)	64.5 (31.0–359.8)	<.001
AST (U/L), median (IQR)	76.5 (37.8–291.0)	43.0 (27.3–102.8)	136.0 (60.8–476.5)	<.001
BUN (mmol/L), median (IQR)	5.8 (4.5–7.7)	4.9 (3.8–6.0)	6.8 (5.3–8.7)	<.001
CR (µmol/L), median (IQR)	129.0 (92.0–166.5)	106.5 (81.8–132.0)	152.0 (109.0–194.3)	<.001
Cystatin C (mg/L)	1.0 (0.8–1.2)	0.9 (0.8–1.1)	1.1 (0.9–1.5)	.001
CK (U/L), median (IQR)	981.0 (425.0–2995.5)	675.0 (212.0–1952.5)	1219.0 (565.3–4415.5)	.004
CKMB (ng/ml), median (IQR)	8.9 (4.5–20.4)	5.3 (3.4–14.3)	14.3 (7.2–26.4)	<.001
Mb (ng/ml), median (IQR)	468.9 (122.0–1000.0)	132.8 (46.9–472.9)	815.7 (371.0–1000.0)	<.001
CTNI (ng/ml), median (IQR)	0.11 (0.02–0.43)	0.02 (0.01–0.05)	0.35 (0.18–1.1)	<.001
PT (s), median (IQR)	16.3 (14.4–22.4)	15.0 (13.7–16.5)	18.9 (15.6–27.1)	<.001
INR median (IQR)	1.3 (1.1–1.9)	1.2 (1.1–1.3)	1.6 (1.3–2.5)	<.001
APTT (s), median (IQR)	40.5 (34.6–58.1)	37.2 (32.5–43.4)	45.6 (36.2–86.4)	<.001
TT (s), median (IQR)	17.9 (16.8–22.6)	17.2 (16.4–18.3)	19.5 (17.5–46.5)	<.001
FIB (g/L), median (IQR)	2.5 (1.9–2.8)	2.6 (2.2–3.1)	2.2 (1.7–2.7)	.001
D-D (mg/L), median (IQR)	2.1 (0.5–7.3)	0.6 (0.3–1.5)	5.3 (1.6–11.4)	<.001
CRP (mg/dl), median (IQR)	3.3 (1.6–5.9)	3.2 (0.7–5.1)	3.3 (2.3–6.5)	.256
PCT (ng/ml), median (IQR)	2.0 (0.8–4.2)	1.4 (0.6–3.3)	2.3 (0.8–5.2)	.019

IQR: Inter-Quartile Range; APACHE II: Acute Physiology and Chronic Health Evaluation II score; SOFA: Sequential Organ Failure Assessment; GCS: Glasgow Coma Score; WBC: White blood cell count; TBIL: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; CR: Creatine; CK: Creatine Kinase; CK-MB: Creatine kinase isoenzymes; CTNI: Cardiac troponin I; PT:Prothrombin time; INR: International normalized ratio; APTT: Activated partial thromboplastin time; TT: Thrombin time; FIB: Fibrinogen; D-D:D-Dimer; CPR: C-reactive protein; PCT: Procalcitonin.

Figure 2. Survival curves of 90-day mortality rate in MI group and Non-MI group.

Table 2. Outcomes of non-MI group and MI group.

All cohort	Non-MI (n = 75)	MI (n = 87)	p-value	p-value*
90-day fatality			<.001	.023
Survivor	74 (98.7%)	66 (76%)
Non-survivor	1 (1.3%)	21 (24%)

*Adjusted: Age, APACHE II: SOFA, GCS, APTT.

Table 3. Baseline characteristics of survivors and non-survivors in patients with MI.

	Total (N = 87)	survivors (N = 66)	Non- survivors (N = 21)	p value
APACHII score, median (IQR)	16.0 (13.0–22.0)	14.0 (12.0–18.0)	22.5 (18.5–24.8)	<.001
SOFA score, median (IQR)	6.0 (3.0–9.0)	4.0 (3.0–6.0)	12.5 (9.3–15.0)	<.001
GCS score, median (IQR)	8.0 (5.0–12.0)	9.0 (6.0–12.0)	4.0 (3.0–7.0)	.001
Age (years), median (IQR)	23.0 (19.0–31.0)	25.5 (20.0–34.3)	22.0 (18.0–25.5)	.120
WBC (1 × 10^9/L), median (IQR)	11.7 (9.2–14.7)	11.8 (9.4–14.7)	10.3 (7.8–15.5)	.448
Neutrophil (1 × 10^9/L), median (IQR)	9.6 (7.4–13.1)	9.9 (7.9–13.0)	8.6 (6.1–13.2)	.248
Lymphocyte (1 × 10^9/L), median (IQR)	0.7 (0.4–1.5)	0.7 (0.4–1.1)	0.7 (0.3–2.8)	.845
Monocytes (1 × 10^9/L), median (IQR)	0.7 (0.4–1.0)	0.7 (0.4–1.0)	0.7 (0.2–0.9)	.254
Platelets (1 × 10^9/L), median (IQR)	90.0 (49.8–166.3)	111.0 (58.5–176.0)	72.0 (29.0–89.0)	.006
Mean platelet volume (%)	10.9 (10.2–11.7)	10.8 (10.1–11.7)	11.0 (10.4–11.8)	.452
Platelet distribution width (%)	12.5 (11.5–14.2)	12.5 (11.2–13.9)	13.1 (11.8–15.7)	.148
TBIL (µmol/L), median (IQR)	20.5 (11.1–44.8)	16.5 (10.5–39.3)	29.9 (12.7–125.4)	.034
ALT (U/L), median (IQR)	64.5 (31.0–359.8)	53.0 (27.5–261.5)	220.0 (70.0–1834.0)	.007
AST (U/L), median (IQR)	136.0 (60.8–456.5)	110.5 (51.0–291.0)	361.5 (112.0–1982.5)	.009
BUN (mmol/L), median (IQR)	6.8 (5.3–8.7)	6.4 (5.2–8.2)	8.1 (5.8–9.8)	.178
CR (µmol/L), median (IQR)	152.0 (109.0–194.3)	135.0 (104.0–168.0)	222.0 (183.5–280.0)	<.001
Cystatin C (mg/L)	1.1 (0.9–1.5)	1.0 (0.8–1.3)	1.5 (1.1–3.1)	.001
CK (U/L), median (IQR)	1219.0 (565.3–4415.5)	1121.0 (492.5–3029.3)	1672.0 (817.8–7931.5)	.072
CKMB (ng/ml), median (IQR)	14.4 (7.2–26.4)	11.9 (5.9–23.9)	18.5 (9.3–46.7)	.049
Mb (ng/ml), median (IQR)	815.7 (371.0–1000.0)	704.1 (250.5–1000.0)	1000.0 (788.1–1000.0)	.029
CTNI (ng/ml), median (IQR)	0.35 (0.18–1.11)	0.28 (0.17–0.64)	1.53 (0.85–3.44)	<.001
PT (s), median (IQR)	18.9 (15.6–27.1)	17.0 (15.4–22.0)	35.0 (22.1–45.0)	<.001
INR median (IQR)	1.6 (1.3–2.5)	1.4 (1.2–1.9)	3.6 (1.9–5.0)	<.001
APTT (s), median (IQR)	45.6 (36.2–86.4)	39.3 (35.1–58.2)	86.1 (59.0–128.9)	<.001
TT (s), median (IQR)	19.5 (17.5–46.5)	18.2 (17.1–24.1)	36.4 (24.3–70.7)	.001
FIB (g/L), median (IQR)	2.2 (1.7–2.7)	2.4 (2.0–2.7)	1.4 (0.9–2.0)	<.001
D-D (mg/L), median (IQR)	5.3 (1.6–11.4)	3.5 (1.2–8.8)	10.1 (10.0–20.0)	<.001
CRP (mg/dl), median (IQR)	3.3 (2.3–6.5)	3.3 (1.8–8.1)	3.3 (3.2–3.6)	.804
PCT (ng/ml), median (IQR)	2.3 (0.8–5.2)	2.1 (0.8–4.8)	3.7 (1.6–7.8)	.092

IQR: Inter-Quartile Range; APACHE II: Acute Physiology and Chronic Health Evaluation II score; SOFA: Sequential Organ Failure Assessment; GCS: Glasgow Coma Score; WBC: White blood cell count; TBIL: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; CR: Creatine; CK: Creatine Kinase; CK-MB: Creatine kinase isoenzymes; CTNI: Cardiac troponin I; PT:Prothrombin time; INR: International normalized ratio; APTT:Activated partial thromboplastin time; TT: Thrombin time; FIB: Fibrinogen; D-D: D-Dimer; CPR: C-reactive protein; PCT: Procalcitonin.

Figure 3. ROC curve analysis of SOFA to assess the 90-day mortality of patients with MI.

Table 4. Risk factors for death in MI patients with severe heat stroke.

Variable	Univariable HR (95%Cl)	p value	Multivarate HR (95%CI)	p value
APACHII	1.124 (1.275–1.447)	<.001	0.514 (0.197–1.336)	.172
SOFA	1.222 (1.432–1.679)	<.001	6.801 (1.047–44.162)	.045
Age	0.918 (0.963–1.011)	.126	0.851 (0.745–0.971)	.017
PLT	0.982 (0.990–0.997)	.009	1.017 (0.990–1.045)	.213
ALT	1.000 (1.000–1.000)	.027	0.999 (0.997–1.001)	.207
AST	1.000 (1.000–1.000)	.037	1.000 (0.999–1.001)	.588
SCR	1.000 (1.003–1.005)	.027	0.990 (0.946–1.036)	.656
APTT	1.003 (1.009–1.016)	.007	1.015 (0.993–1.039)	.185
DD	1.014 (1.031–1.047)	<.001	1.055 (0.937–1.188)	.378
CKMB	0.998 (1.004–1.009)	.197	1.026 (0.985–1.068)	.213
Mb	1.000 (1.000–1.001)	.134	1.000 (0.996–1.004)	.942
WBC	0.888 (0.979–1.080)	.676	1.116 (0.825–1.510)	.475
PCT	0.990 (1.050–1.114)	.103	0.806 (0.615–1.057)	.119

APACHE II: Acute Physiology and Chronic Health Evaluation II score; SOFA: Sequential Organ Failure Assessment; GCS: Glasgow Coma Score; ALT: Alanine aminotransferase; CR: Creatine; INR: International normalized ratio; FIB: Fibrinogen; D-D:D-Dimer; PCT: Procalcitonin; PLT: Platelets.