Gastrointestinal manifestations of critical ill heatstroke patients and their associations with outcomes: A multicentre, retrospective, observational study

Abstract

Background: Extreme heat exposure is a growing health problem, and the effects of heat on the gastrointestinal (GI) tract is unknown. This study aimed to assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes.

Aim: To assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes.

Methods: Patients admitted to the intensive care unit (ICU) due to heatstroke were included from 83 centres. Patient history, laboratory results, and clinically relevant outcomes were recorded at ICU admission and daily until up to day 15, ICU discharge, or death. GI symptoms, including nausea/vomiting, diarrhoea, flatulence, and bloody stools, were recorded. The characteristics of patients with heatstroke concomitant with GI symptoms were described. Multivariable regression analyses were performed to determine significant predictors of GI symptoms.

Results: A total of 713 patients were included in the final analysis, of whom 132 (18.5%) patients had at least one GI symptom during their ICU stay, while 26 (3.6%) suffered from more than one symptom. Patients with GI symptoms had a significantly higher ICU stay compared with those without. The mortality of patients who had two or more GI symptoms simultaneously was significantly higher than that in those with one GI symptom. Multivariable logistic regression analysis revealed that older patients with a lower GCS score on admission were more likely to experience GI symptoms.

Conclusion: The GI manifestations of heatstroke are common and appear to impact clinically relevant hospitalization outcomes.

Keywords: Diarrhea; Extreme heat; Flatulence; Intensive care units; Sunstroke.

Figure 1

Flow chart of the study. Patients were grouped according to whether gastrointestinal (GI) symptoms occurred on intensive care unit (ICU) admission, then whether GI symptoms occurred during ICU hospitalization and the onset of patients’ GI symptoms. ICU: Intensive care unit; GI: Gastrointestinal; w: With; o: Without.

Figure 2

Number of patients with gastrointestinal symptoms and total number of heatstroke patients still in the intensive care unit per day.

Figure 3

Multivariable-adjusted logistic regression of risk factors with gastrointestinal symptoms. A: It showed multivariable logistic regression between heatstroke patients’ gastrointestinal (GI) symptoms with age, sex, body mass index (BMI) Glasgow coma scale (GCS) score, nutrition risk screening 2002 (NRS-2002) score, high temperature exposed duration and patients’ temperature; B: It is adjusted for coexisting disorder and index in Figure 3A; C: It is adjusted for laboratory results at intensive care unit admission and index in Figure 3A. Age is a categorical variable bounded by the median age of the patient, with less than the median age being compared. Sex is the categorical variable, with women being compared. BMI, GCS score, NRS-2002, exposed duration and temperature are continuous variables. Diabetes, hypertension, chronic obstructive disease, chronic cardiac insufficiency, abnormal white cell count, PaO₂/FiO₂ ratio and hemoglobin are categorical variable. BMI: Body mass index; GCS score: Glasgow coma scale score; NRS-2002 score: Nutrition risk screening-2002 score; OR: Odds ratio; PF ratio: PaO₂/FiO₂ ratio; HB: Hemoglobin.