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<p>Exertional heatstroke (EHS) often leads to multiple organ dysfunction syndrome (MODS) with high mortality. The liver is frequently early damaged in EHS, presenting as acute liver injury (ALI), including acute liver disease (ALD) and acute liver failure (ALF). This study investigates liver enzyme changes in EHS patients, assesses whether ALF independently predicts in-hospital mortality, and tries to create an ALF-based predictive model for EHS. This was a single-center retrospective study. The medical records of EHS patients admitted to the intensive care unit (ICU) of a tertiary hospital from January 1, 2008 to December 31, 2023, were recorded and analyzed. The characteristics of liver damage were analyzed by reviewing the enzymatic indices of EHS patients from day 1 to day 9 after admission. There were 176 male patients ultimately analyzed, comprising 160 survivors and 16 non-survivors. Univariate and multivariate logistic regression analysis showed that prolonged activated partial thromboplastin time (APTT) (OR = 1.029, <i>P</i> = 0.018), increased γ-glutamyltransferase (γ-GGT) (OR = 1.032, <i>P</i> = 0.013), and ALF (OR = 57.238, <i>P</i> = 0.002) were independent risk factors for predicting in-hospital mortality. Approximately half of the patients (48.3%) were diagnosed as ALI. Notably, 81.8% of the ALF cases were diagnosed within 5 days after EHS onset. The predictive model based on increased heart rate (HR) (OR = 1.065, <i>P</i> &lt; 0.001), increased platelet (PLT) count (OR = 0.989, <i>P</i> = 0.034), and increased fibrinogen (Fib) (OR = 0.216, <i>P</i> = 0.002) level had a higher specificity and better predictive performance (SEN = 86.4%, SPE = 90.8%, AUC = 0.936) for occurrence of ALF in EHS. During the early stages of EHS, patients exhibited multiple organ injuries, with a high ALI incidence rate. ALF, prolonged APTT, and elevated γ-GGT levels were the independent risk factors for in-hospital mortality in EHS patients. The predictive model based on HR, PLT, and Fib levels was potentially suitable and practical for early identification and timely management of ALF in EHS patients.</p>

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Liver enzyme trajectory and risk factors for acute liver failure in patients with exertional heatstroke: a retrospective analysis

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Fanfan Wang,
  • Kun Wu,
  • Xuezhi Shi,
  • Lian Xie,
  • Gan Lin,
  • Jinhu Li,
  • Binli Ma,
  • Huilin Zhang,
  • Kaiyi Huang,
  • Huasheng Tong

摘要

Exertional heatstroke (EHS) often leads to multiple organ dysfunction syndrome (MODS) with high mortality. The liver is frequently early damaged in EHS, presenting as acute liver injury (ALI), including acute liver disease (ALD) and acute liver failure (ALF). This study investigates liver enzyme changes in EHS patients, assesses whether ALF independently predicts in-hospital mortality, and tries to create an ALF-based predictive model for EHS. This was a single-center retrospective study. The medical records of EHS patients admitted to the intensive care unit (ICU) of a tertiary hospital from January 1, 2008 to December 31, 2023, were recorded and analyzed. The characteristics of liver damage were analyzed by reviewing the enzymatic indices of EHS patients from day 1 to day 9 after admission. There were 176 male patients ultimately analyzed, comprising 160 survivors and 16 non-survivors. Univariate and multivariate logistic regression analysis showed that prolonged activated partial thromboplastin time (APTT) (OR = 1.029, P = 0.018), increased γ-glutamyltransferase (γ-GGT) (OR = 1.032, P = 0.013), and ALF (OR = 57.238, P = 0.002) were independent risk factors for predicting in-hospital mortality. Approximately half of the patients (48.3%) were diagnosed as ALI. Notably, 81.8% of the ALF cases were diagnosed within 5 days after EHS onset. The predictive model based on increased heart rate (HR) (OR = 1.065, P < 0.001), increased platelet (PLT) count (OR = 0.989, P = 0.034), and increased fibrinogen (Fib) (OR = 0.216, P = 0.002) level had a higher specificity and better predictive performance (SEN = 86.4%, SPE = 90.8%, AUC = 0.936) for occurrence of ALF in EHS. During the early stages of EHS, patients exhibited multiple organ injuries, with a high ALI incidence rate. ALF, prolonged APTT, and elevated γ-GGT levels were the independent risk factors for in-hospital mortality in EHS patients. The predictive model based on HR, PLT, and Fib levels was potentially suitable and practical for early identification and timely management of ALF in EHS patients.