Association between normal saline infusion volume in the emergency department and acute kidney injury in heat stroke patients: a multicenter retrospective study.

BACKGROUND: Previous studies have shown that intravenous normal saline (NS) may be associated with the incidence of acute kidney injury (AKI). This study aimed to evaluate the association between the volume of NS infusion and AKI in heat stroke (HS) patients. METHODS: This multicenter retrospective cohort study included 138 patients with HS. The primary outcome was the incidence of AKI. Secondary outcomes included the need for continuous renal replacement therapy (CRRT), admission to the intensive care unit (ICU), length of stay in the ICU and hospital, and in-hospital mortality. Multivariate regression models, random forest imputation, and genetic and propensity score matching were used to explore the relationship between NS infusion and outcomes. RESULTS: The mean volume of NS infusion in the emergency department (ED) was 3.02 ± 1.45 L. During hospitalization, 33 patients (23.91%) suffered from AKI. In the multivariate model, as a continuous variable (per 1 L), the volume of NS infusion was associated with the incidence of AKI (OR, 2.51; 95% CI, 1.43-4.40; p = .001), admission to the ICU (OR, 3.46; 95% CI 1.58-7.54; p = .002), and length of stay in the ICU (ß, 1.00 days; 95% CI, 0.44-1.56; p < .001) and hospital (ß, 1.41 days; 95% CI, 0.37-2.45; p = .008). These relationships also existed in the forest imputation cohort and matching cohort. There were no differences in the use of CRRT or in-hospital mortality. CONCLUSIONS: The volume of NS infusion was associated with a significant increase in the incidence of AKI, admission to the ICU, and length of stay in the ICU and hospital among patients with HS.

The association of standard base excess upon emergency admission with outcomes in patients with heat stroke.

OBJECTIVES: Standard base excess (SBE) is a quick and effective tool to identify acid-base disorders in critically ill patients, independent of respiratory factors. The predictive value of SBE for adverse outcomes in patients with heat stroke (HS) is still unclear. This study aimed to explore the prognostic significance of SBE for in-hospital mortality and other adverse outcomes in patients with HS. METHODS: A retrospective, observational multicenter cohort study with consecutive patients between 2021 and 2022 was conducted. The SBE was performed upon emergency department (ED) admission. The primary outcome was in-hospital mortality. Secondary outcomes included the use of vasoactive drugs in the ED, admission to the ICU, acute kidney failure, acute heart failure, acute respiratory failure, sepsis, and coagulation impairment. Logistic regression models and receiver operating characteristic (ROC) curves were used to estimate the association of SBE with outcomes in HS patients. Interaction and stratified analyses were also conducted. RESULTS: The median level of SBE was -4.70 (-8.05- -1.55) mmol/L. Overall hospital mortality in these 151 HS patients was 12.58%. SBE was independently associated with hospital mortality (OR 0.81, 95% CI 0.70-0.95, P = 0.011). Age and HS type played interactive roles in the relationship between SBE and in-hospital mortality. The OR between SBE and hospital mortality was 0.5 (95% CI, 0.3-0.9; p < 0.018) in classic HS participants and 0.62 (95% CI, 0.45-0.87; p = 0.005) in participants aged >65 years. The AUC of SBE to predict in-hospital mortality was 0.868 (95% CI: 0.704-0.962) and 0.883 (95% CI: 0.750-0.951) in these two groups, respectively. SBE was significantly associated with admission to the ICU, acute kidney failure, acute respiratory failure, sepsis, and coagulation impairment. CONCLUSION: SBE upon emergency admission was significantly associated with adverse outcomes in patients with HS.

Measurement of Hounsfield units on proximal femur computed tomography for predicting regional osteoporosis.

OBJECTIVE: This study was designed to investigate the use of proximal femoral Hounsfield units (HU) in conventional abdominal and pelvic computed tomography (CT) to predict hip osteoporosis by coupling with data from quantitative CT (QCT). METHODS: In this study, 315 patients who underwent routine abdominal and pelvic CT with the proximal femur included in the scanning range were also subjected to QCT of the proximal femur. Pearson correlation test was performed to analyze the correlations of the femoral head, femoral neck, proximal femur, and femoral trochanter CT HU with the femoral neck, femoral trochanter, and intertrochanteric femur bone mineral density (BMD) values from QCT. The diagnostic performance of CT HU measurement of the proximal femur for osteoporosis was analyzed using receiver operating characteristic (ROC) curves. RESULTS: The CT HU of the proximal femur showed the highest correlation with the BMD value of the hip (r = 0.826; p < 0.01). The mean CT HU of the proximal femur differed significantly (all p < 0.01) for the three QCT-defined BMD categories of osteoporosis (192.23 HU vs. 188.71), of osteopenia (247.86 HU vs. 248.36 HU), and of normal individuals (308.13 HU vs. 310.41 HU) in left and right sides, respectively. In the ROC curve analysis, the area under the ROC curve values to predict osteoporosis in the left and right proximal femurs were 0.942 and 0.941, respectively. CONCLUSION: The CT HU of the proximal femur was significantly associated with the BMD value of the hip measured by QCT. The CT HU of the proximal femur is highly effective in diagnosing osteoporosis and could be used for hip osteoporosis screening.

Association between cooling temperature and outcomes of patients with heat stroke.

This study explored the relationship between body temperature and adverse outcomes in patients with heat stroke to identify the optimal target body temperature within the first 24 h. This retrospective, multicentre study enrolled 143 patients admitted to the emergency department and diagnosed with heat stroke. The primary outcome was the in-hospital mortality rate, while secondary outcomes included the presence and number of damaged organs and neurological sequelae at discharge. A body temperature curve was built using a generalized additive mixed model, and the association between body temperatures and outcomes was established by logistic regression. The threshold and saturation effects were used to explore the targeted body temperature management. Cases were divided into the surviving and non-surviving groups. The cooling rate within the first 2 h was significantly higher in the survival group than the non-survival group (ß: 0.47; 95% confidence interval [CI]: 0.09-0.84; P = 0.014), while the non-survival group exhibited a lower body temperature within 24 h (ß: - 0.06; 95% CI: - 0.08 to - 0.03; P ≤ 0.001). Body temperature after 2 h (odds ratio [OR]: 2.27; 95% CI: 1.14-4.50; P = 0.019) and lowest temperature within 24 h (OR: 0.18; 95% CI: 0.06-0.55; P = 0.003) were significantly related to in-hospital mortality rate. When the body temperature at 0.5 h was 38.5-40.0 °C, the number of damaged organs was at its lowest. In patients with heat stroke, both hyperthermia and hypothermia were associated with adverse outcomes. Hence, an accurate body temperature management is required during the early stages of care.

[The evaluation of virtual endoscopy and fiberoptic endoscopy in the diagnosis of obstructive sleep apnea syndrome].

OBJECTIVE: The utility of virtual endoscopy is compared to fiberoptic endoscopy and was also investigated with respect to accuracy of diagnosis and reproduction of images in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: Twenty-one patients with OSAHS were examined by helical spiral CT axial images and fiberoptic endoscopy. The helical spiral CT axial data was reconstructed using a VE software program. The results were compared to the fiberoptic endoscopic findings done by the otolaryngologists. All the patients were examined both in the sleeping and nonsleeping status. The dimensions of soft palate, uvula, lingua and epiglottis region were evaluated. RESULT: The results both in the virtual endoscopy evaluation and fiberoptic endoscopy was statistically significant difference in all of region. In the palate region, there was statistically significant difference in the left-and-right dimension, but no difference in the fore-and-aft dimension both in the sleeping and nonsleeping status. CONCLUSION: The dimensions of upper airway were more difference between in the sleeping and nonsleeping status. The change of dimension was more in the left-and-right; the fiberoptic endoscopy has more diagnostic significance in evaluation of dynamic movement of the upper airway; virtual endoscopy evaluation of the upper airway was accurate in assessing stenosis width and length; virtual endoscopy added more information about anatomic structure and pathological change of the upper airway.