A novel indicator for temperature control in heat stroke treatment

Background: Temperature control plays a pivotal role in patients with heat stroke (HS), but little work has been done sufficiently on the use of temperature control to reflect disease progression. Here, we defined and analyzed the concrete role of controlling time for core temperature to physiological level (CTTP), in order to explore a potential index to guide the treatment of HS.Method: This is a retrospective cohort study. From three hospitals located in Sichuan province, China, we collected a total of 179 HS cases with clinical diagnosis and treatment records. We defined CTTP as the time interval of HS onset to stabilization of core temperature (rectal temperature) below 37.7degree celsius and analyzed the correlation between CTTP and inpatient death of HS patients.Results: Of all the cases, 64.80% were male and 53.07% were exertional heat stroke (EHS). The median (IQR) age was 59 (23.5-73) years old, and the median (IQR) onset temperature was 42 (40.4-42)degree celsius. Multivariable analysis demonstrated significantly high inpatient death in the highest CTTP tertile (>18 h) (hazard ratio: 18.75; 99% confidence interval: 4.06-86.59; p = .0002). In addition, compared with patients in lowest CTTP tertile, patients in highest CTTP tertile were at significantly higher risk of organ damage: 3.48-fold for respiratory failure (95% CI: 1.41-8.59, p = .0069); 3.18-fold for shock (95% CI: 1.37-7.39, p = .0071); 4.09-fold for rhabdomyolysis (95% CI: 1.73-9.64, p = .0013); 4.64-fold for renal damage (95% CI: 2.12-10.14, p = .0001).Conclusion: Long of CTTP predicts inpatient death of HS patients with a CTTP tertile >18 h associated with the highest rate of inpatient death.