Preliminary Study On Risk Factors Of Prognosis In Patients With Severe Heat Stroke And Logistic Regression Analysis

Objective : Heatstroke is in high temperature,high humidity and wind environment,regulating heatstroke dysfunction in the body temperature,sweat failure,water and electrolyte metabolism lost too much for the characteristics of the disease,according to clinical manifestations were divided into mild symptoms of premonitory heatstroke and severe heatstroke,and severe heatstroke include heat cramps,heat exhaustion and heatstroke,Subsequent multiple organ failure(MODS)is often life-threatening.In order to summarize the experience,find out better rules and guide the treatment,effects of severe heatstroke analysis standard prediction of patients with high risk factors and establish the prognosis of patients with severe heatstroke,put forward reasonable suggestions,early support and symptomatic treatment,reduce the mortality rate and disability rate risk.Methods:From July 2012 to September 2016 during the summer the clinical data of the Second Affiliated Hospital of Nanchang University and the Third Hospital of Nanchang emergency department patients with severe heat stroke,according to clinical manifestation,examination index and prognosis were retrospectively analyzed.(1)106 cases of severe heatstroke patients were collected.83 cases were male and23 females,age is form 26-92 years old,the average is(51.67±16.86)years.Previous history of heat stroke: 94 cases of body building,high blood pressure in 5 cases,diabetes in 4 cases,cerebral infarction in 2 cases,heart disease in 1 cases.According to the prognosis,in which 20 patients died and 86 cases survival.(2)By using the univariate analysis(Age,Sex,Basic disease,Breathing,Pulse,Temperature,WBC,PLT,HG,ALT,AST,GLU,SCR,CK,CK—MB,Na+,K+,PT,APTT,PH,the number of organ faikure,GCS score,APACHE Ⅱ score,physical discomfort and etc.)respectively by single factor analysis and multivariate Logistic regression analysis,find out the threatening factors for death in patients with severe heatstroke in clinic.And to establish the forecasting model of death in patients with severe heat stroke,the clinical data were included in the model to map out theoperating characteristic curve(the receiver operating characteristic curve,ROC curve)and worked out the area under ROC curve(AUC).Comparison of predictive model and APACEⅡscore in evaluating the prognosis of patients with severe heat stroke.Finally,will collect the clinical data by Logistic equation,further verify the prediction model of early judgment.Results:Retrospective univariate analysis showed that: there was a significant temperature,age,R,P,basic disease,PLT,AST,CK,SCR,PT,PH,GCS score and the number of organ failure and APACE Ⅱ score in 86 patients live group was statistically difference with that of 20 death group(P<0.05),are the prognostic of patients with severe heatstroke.Multivariate Logistic regression analysis showed that CK was independent risk factors for the prognosis of severe heat stroke.The prediction model ROC curve is described and the curve AUC=0.998 is calculated,and the 95% confidence interval0.986to1.109.And compared with GSC score and APACE Ⅱ score the of the new diagnosis model is larger than both(p<0.000),the sensitivity and specificity were higher than the APACE Ⅱ score,and the data acquisition is convenient and fast,the overall score is better than that of APACE Ⅱscore.Conclusion : Severe heatstroke in the course of the disease,whether accompanied by age,basic disease,T,R,P,,PLT,AST,CK,SCR,PT,PH,GCS score and APACE Ⅱ score multiple organ failure,to determine the prognosis of severe heatstroke help.Especially CK is an independent risk factor for death in patients with severe heat stroke,real-time monitoring,timely,early symptomatic treatment,for patients with disease control and improve the prognosis plays a key role.