Do exertional heat stroke and environmental heat involve epigenetic memory?

Horowitz, Michal

doi:10.1113/jp280928

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…This may be particularly important where the affected individual will be unaccompanied upon discharge, or subsequent heat tolerance testing is available and relatively indicated [ 12 ]. In such circumstances, an early indication of established or evolving organ injury could help inform whether ongoing clinical supervision is indicated and/or aid assessment of the likelihood of increased risk associated with further bouts of exercise and thermal stress [ 13 ]. In this sense, a reproducible physiological index to discriminate EHS with downstream clinical sequelae from lesser kinds of incapacity could help tailor a clinical pathway from collapse to recovery.…”

Section: Introductionmentioning

confidence: 99%

Relative changes in brain and kidney biomarkers with Exertional Heat Illness during a cool weather marathon

et al. 2022

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Background Medical personnel may find it challenging to distinguish severe Exertional Heat Illness (EHI), with attendant risks of organ-injury and longer-term sequalae, from lesser forms of incapacity associated with strenuous physical exertion. Early evidence for injury at point-of-incapacity could aid the development and application of targeted interventions to improve outcomes. We aimed to investigate whether biomarker surrogates for end-organ damage sampled at point-of-care (POC) could discriminate EHI versus successful marathon performance. Methods Eight runners diagnosed as EHI cases upon reception to medical treatment facilities and 30 successful finishers of the same cool weather marathon (ambient temperature 8 rising to 12 ºC) were recruited. Emerging clinical markers associated with injury affecting the brain (neuron specific enolase, NSE; S100 calcium-binding protein B, S100β) and renal system (cystatin C, cysC; kidney-injury molecule-1, KIM-1; neutrophil gelatinase-associated lipocalin, NGAL), plus copeptin as a surrogate for fluid-regulatory stress, were sampled in blood upon marathon collapse/completion, as well as beforehand at rest (successful finishers only). Results Versus successful finishers, EHI showed significantly higher NSE (10.33 [6.37, 20.00] vs. 3.17 [2.71, 3.92] ug.L-1, P<0.0001), cysC (1.48 [1.10, 1.67] vs. 1.10 [0.95, 1.21] mg.L-1, P = 0.0092) and copeptin (339.4 [77.0, 943] vs. 18.7 [7.1, 67.9] pmol.L-1, P = 0.0050). Discrimination of EHI by ROC (Area-Under-the-Curve) showed performance that was outstanding for NSE (0.97, P<0.0001) and excellent for copeptin (AUC = 0.83, P = 0.0066). Conclusions As novel biomarker candidates for EHI outcomes in cool-weather endurance exercise, early elevations in NSE and copeptin provided sufficient discrimination to suggest utility at point-of-incapacity. Further investigation is warranted in patients exposed to greater thermal insult, followed up over a more extended period.

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Section: Introductionmentioning

confidence: 99%