[Fever as a prognostic factor for heat stroke]

Abstract

Objectives: Classic heatstroke that is, due to very hot weather, rare in Europe. Its clinical characteristics and course in temperate zones are not well known. The objective of this study was to assess the influence of initial fever on prognosis in heatstroke.

Methods: All patients admitted through the emergency department from 8-13 August 2003 for heatstroke (defined by fever > or = 40 degrees C, with neurologic symptoms in the absence of sepsis) were included in the study. Patients' clinical and laboratory indicators were recorded at admission. Follow-up took place at D28 and 1 year. The influence of fever on survival was assessed with the Kaplan-Meier method.

Results: During the study period, 63 patients, aged 78+/-9 years, were admitted for heatstroke, with a SAPS II (Simplified Acute Physiology Score) of 61+/-24. Core body temperature was 41.4+/-1.2 degrees C. Mortality was 59% at D28 and 67% at 1 year. Prognosis was influenced from admission by temperature, with a higher probability of survival for patients with temperature < 41 degrees C, compared with those whose temperature > or = 41 degrees C (log-rank test: p<0.001).

Discussion: Prognosis is poor for classic heatstroke. Rapid temperature reduction, especially when it exceeds > 41 degrees C, must be considered a priority. Fever > or = 41 degrees C at admission for heatstroke is a poor prognostic factor that is simple to identify and may modify treatment strategies in the future.