Skip to main content
SpringerLink
Log in

Prognostic factors in non-exertional heatstroke

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 21 November 2009

Abstract

Purpose

To identify the prognostic factors associated with mortality in heat-related illness.

Methods

Multi-center observational cohort-study in 16 emergency departments (ED) belonging to the teaching hospital network of the Paris area. The cohort comprised all patients admitted to one of the EDs during the August 2003 heat wave in Paris and having a core temperature >38.5°C. Baseline clinical and biological data in ED, patient’s course and 1-year survival rate were recorded. Potential prognostic factors associated with death were assessed by Cox proportional-hazards analysis.

Results

A total of 1,456 patients were included. Mean age was 79 ± 19 years. Critically ill conditions were noted in 391 patients (27%), but only 72 (5%) were admitted into an intensive care unit. The survival rate was 57% at 1 year as compared to an expected 90% (P < 0.001). Nine independent prognostic factors were identified: previous treatment with diuretics, living in an institution, age >80 years, cardiac disease, cancer, core temperature >40°C, systolic arterial pressure <100 mmHg, Glasgow coma scale <12 and transportation to hospital by ambulance. We defined three risk groups: low, intermediate and high risk, with a 1-year survival rate of 85, 61 and 18%, respectively.

Conclusions

We observed a low survival rate and developed a risk score based on easily obtained variables that may be useful to clinicians managing casualties from future heat waves.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bouchama A, Knochel JP. (2002) Heatstroke. N Engl J Med 346:1978–1988

  2. Jones TS, Liang AP, Kilbourne EM, Griffin MR, Patriarca PA, Wassilak SG, Mullan RJ, Herrick RF, Donnell HD Jr, Choi K, Thacker SB (1982) Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, MO. JAMA 247:3327–3331

    Article  CAS  PubMed  Google Scholar 

  3. Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL (1996) Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 335:84–90

    Article  CAS  PubMed  Google Scholar 

  4. Rooney C, Mc Michael AJ, Kovats RS, Coleman P (1998) Excess mortality in England and Wales and in Greater London, during the 1996 heatwave. J Epidemiol Community Health 52:482–486

    Article  CAS  PubMed  Google Scholar 

  5. Patz JA, Campbell-Lendrum D, Holloway T, Foley JA (2005) Impact of regional climate change on human health. Nature 438:310–317

    Article  CAS  PubMed  Google Scholar 

  6. Dhainaut JF, Claessens YE, Ginsburg C, Riou B (2004) Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments. Crit Care 8:1–2

    Article  PubMed  Google Scholar 

  7. Al Bubrek D, Bakon S, Moran DS, Faibel M, Epstein Y (1997) Heat stroke-induced cerebellar atrophy: clinical course, CT and MRI findings. Neuradiology 39:195–197

    Article  Google Scholar 

  8. Fouillet A, Rey G, Laurent F, Pavillon G, Bellec S, Guihenneuc-Jouyaux C, Clavel J, Jougla E, Hémon D (2006) Excess mortality related to the August 2003 heat wave in France. Int Arch Occup Environ Health 80:16–24

    Article  CAS  PubMed  Google Scholar 

  9. Argaud L, Ferry T, Le QH, Marfisi A, Ciorba D, Achache P, Ducluzeau R, Robert D (2007) Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France. Arch Intern Med 167:2177–2183

    Article  PubMed  Google Scholar 

  10. O’Neill MS, Zanobetti A, Schwartz J (2003) Modifiers of the temperature and mortality association in seven US cities. Am J Epidemiol 157:1074–1082

    Article  PubMed  Google Scholar 

  11. Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A, Anderson HR, Bisanti L, D’Ippoliti D, Danova J, Forsberg B, Medina S, Paldy A, Rabczenko D, Schindler C, Michelozzi P (2008) Heat effects on mortality in 15 European cities. Epidemiology 19:711–719

    Article  PubMed  Google Scholar 

  12. Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B (2007) Prognostic factors in heat wave-related deaths. A meta-analysis. Arch Intern Med 167:2170–2176

    Article  PubMed  Google Scholar 

  13. Misset B, de Jonghe B, Bastuji-Garin S, Gattolliat O, Boughrara E, Annane D, Hausfater P, Garrouste-Orgeas M, Carlet J (2006) Mortality of patients with heatstroke admitted to intensive care units during the 2003 heat wave in France: a National-multicenter risk-factor study. Crit Care Med 34:1087–1092

    Article  PubMed  Google Scholar 

  14. Pease S, Bouadma L, Kermarrec N, Schortgen N, Régnier B, Wolff M (2009) Early organ dysfunction course, cooling time and outcome in classic heatstroke. Intensive Care Med 35:1454–1458

    Article  PubMed  Google Scholar 

  15. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919

    CAS  PubMed  Google Scholar 

  16. Rivera R, Antognini JF (2009) Perioperative drug therapy in elderly patients. Anesthesiology 110:1176–1181

    Article  PubMed  Google Scholar 

  17. Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A (2008) Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome: propensity-adjusted analyses. Anesthesiology 108:979–987

    Article  CAS  PubMed  Google Scholar 

  18. Molinaro AM, Simon R, Pfeiffer RM (2005) Prediction error estimation: a comparison of resampling method. Bioinformatics 21:3301–3307

    Article  CAS  PubMed  Google Scholar 

  19. Efron B, Tibshirani RJ (1993) An introduction to the bootstrap. Chapman & Hall, New York

    Google Scholar 

  20. Dematte JE, O’Mara K, Buescher J, Whitney CG, Forsythe S, McNamee T, Adiga RB, Ndukwu IM (1998) Near-fatal Heat stroke during the 1995 heat wave in Chicago. Ann Intern Med 129:173–181

    CAS  PubMed  Google Scholar 

  21. Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B (2007) Serum procalcitonin measurements as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care 11:R60

    Article  PubMed  Google Scholar 

  22. Hausfater P, Riou B (2007) Coup de chaleur Encycl Med Chir Urgences 24-116-A20. Elsevier, Paris

  23. Huisse MG, Pease S, Hurtado-Nedelec M, Arnaud B, Malaquin C, Wolff M, Gougerot-Pocidalo MA, Kermarrec N, Bezeaud A, Guillin MC, Paoletti X, Chollet-Martin S (2008) Leukocyte activation: the link between inflammation and coagulation during heatstroke. A study of patients during the 2003 heat wave in Paris. Crit Care Med 36:2455–2456

    Article  Google Scholar 

  24. Claessens YE, Taupin P, Kierzek G, Pourriat JL, Baud M, Ginsburg C, Jais JP, Jougla E, Riou B, Dhainaut JF, Landais P (2006) How emergency departments might alert for prehospital heat-related excess mortality? Crit Care 10:R156

    Article  PubMed  Google Scholar 

  25. Kaarlola A, Tallgren M, Pettila V (2006) Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 34:2120–2126

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are indebted to Emmanuelle de Magondeau and Christine Lanau for their excellent data monitoring and management. We thank Dr. David J. Baker, DM, FRCA (Department of Anesthesiology, CHU Necker-Enfants Malades, Paris, France) for reviewing the manuscript and Prof. Paul Landais, MD, PhD (Department of Biostasistics, CHU Necker-Enfants Malades, France) and Yannick Le Manach (Department of Anesthesiology and Critical Care, CHU Pitié-Salpêtrière, Paris, France) for statistical advice. The study was supported by the Direction Régionale de la Recherche Clinique d’Ile de France (Paris, France), grant no. CRC 03-150.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Emergency Department, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris, Paris, France

    Pierre Hausfater & Bruno Riou

  2. Critical Care Department, Centre Hospitalo-Universitaire (CHU) Lariboisière, Assistance-Publique Hôpitaux de Paris, Paris, France

    Bruno Megarbane

  3. Emergency Department, Centre Hospitalo-Universitaire (CHU) Tenon, Assistance-Publique Hôpitaux de Paris, Paris, France

    Sandrine Dautheville

  4. Emergency Department, Centre Hospitalo-Universitaire (CHU) George Pompidou, Assistance-Publique Hôpitaux de Paris, Paris, France

    Anabella Patzak

  5. Emergency Department, Centre Hospitalo-Universitaire (CHU) Antoine Béclère, Assistance-Publique Hôpitaux de Paris, Clamart, France

    Marc Andronikof

  6. Emergency Department, Centre Hospitalo-Universitaire (CHU) Henri Mondor, Assistance-Publique Hôpitaux de Paris, Créteil, France

    Aline Santin

  7. Emergency Department, Centre Hospitalo-Universitaire (CHU) Cochin-St Vincent de Paul, Assistance-Publique Hôpitaux de Paris, Paris, France

    Stéphanie André

  8. Emergency Department, Centre Hospitalo-Universitaire (CHU) Ambroise Paré, Assistance-Publique Hôpitaux de Paris, Boulogne, France

    Ludovic Korchia

  9. Emergency Department, Centre Hospitalo-Universitaire (CHU) Bichat-Claude Bernard, Assistance-Publique Hôpitaux de Paris, Paris, France

    Nabila Terbaoui

  10. Emergency Department, Centre Hospitalo-Universitaire (CHU) Hôtel Dieu, Assistance-Publique Hôpitaux de Paris, Paris, France

    Gérald Kierzek

  11. Emergency Department, Centre Hospitalo-Universitaire (CHU) Bicêtre, Assistance-Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France

    Benoît Doumenc

  12. Emergency Department, Centre Hospitalo-Universitaire (CHU) Louis Mourier, Assistance-Publique Hôpitaux de Paris, Colombes, France

    Christophe Leroy

  13. Service d’Accueil des Urgences, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l’hôpital, 75013, Paris, France

    Pierre Hausfater

Authors
  1. Pierre Hausfater
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruno Megarbane
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandrine Dautheville
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anabella Patzak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc Andronikof
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aline Santin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stéphanie André
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ludovic Korchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nabila Terbaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gérald Kierzek
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Benoît Doumenc
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Christophe Leroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Bruno Riou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierre Hausfater.

Additional information

The other investigators in the study are listed in the Appendix.

An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-009-1728-5

Appendix

Appendix

The other investigators were (in alphabetical order): Joëlle Benkel (CHU Jean Verdier, Bondy), Dominique Brun-Ney, MD (CHU Ambroise Paré, Boulogne, currently the Direction de la Politique Médicale, Assistance Publique-Hôpitaux de Paris), Enrique Casalino, MD, PhD (CHU Bicêtre, Le Kremlin-Bicêtre, currently CHU Bichat and Université Denis Diderot-Paris 7), Alain Davido (Hôpital Européen Georges Pompidou, Paris), MD, Jean-François Dhainaut, MD (CHU Cochin-St Vincent de Paul and Université René Descartes-Paris 5, currently the Agence de l’Evaluation de la Recherche et de l’Enseignement Supérieur, Paris, France), David Elkharrat, MD (CHU Lariboisière, Paris, currently CHU Ambroise Paré, Boulogne, and Université Paris Ouest), Anika Fichelle (CHU Bichat Claude-Bernard, Paris), M.D., Bertrand Galichon MD (CHU Lariboisière, Paris), Christine Ginsburg, MD, (CHU Cochin-St Vincent de Paul, Paris), Philippe Héricord MD (CHU Saint Antoine, Paris), Philippe Hoang, MD (deceased) (CHU Avicenne, Bobigny), Côme Légaut, MD, (CHU Antoine Béclère, Clamart), Virginie Lemiale, MD (CHU Henri Mondor, Créteil), Jafar Manamani, MD (CHU Saint Louis, Paris, currently CHU Saint Antoine, Paris), Alice Marichez, MD, and Dominique Meyniel, MD (CHU Tenon, Paris), Dominique Pateron, MD, PhD (CHU Jean Verdier, Bondy, currently CHU Saint-Antoine and Université Pierre et Marie Curie-Paris 6), Florence Péviriéri, MD (CHU Jean Verdier, Bondy), Jean-Louis Pourriat, MD (CHU Hôtel Dieu, Paris and Université René Descartes-Paris 5), Bertrand Renaud, MD (CHU Henri Mondor, Créteil), Pierre Taboulet, MD (CHU Saint Louis, Paris), Stéphane Wadjou, MD, (CHU Pitié-Salpêtrière, Paris), Patrick Werner MD (CHU Beaujon, Clichy); all in emergency departments of Assistance Publique-Hôpitaux de Paris, Paris, France.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hausfater, P., Megarbane, B., Dautheville, S. et al. Prognostic factors in non-exertional heatstroke. Intensive Care Med 36, 272–280 (2010). https://doi.org/10.1007/s00134-009-1694-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-009-1694-y

Keywords

Search

Navigation