Successful treatment with hydrocortisone for heat stroke with critical illness-related corticosteroid insufficiency: transitional changes in serum cytokine and cortisol concentrations

Miyauchi, Takashi; Tsuruta, Ryosuke; Kutsuna, Satoshi; Nakahara, Takashi; Fujita, Motoki; Kasaoka, Shunji; Maekawa, Taira

doi:10.1007/s00540-008-0725-0

Cited by 5 publications

(4 citation statements)

References 14 publications

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“… 27 One of these manifestations is the decreased expression of mHLA‐DR, which can possibly cause immune suppression and accelerate the development of sepsis. 28 Elevated levels of glucocorticoids 29 and interleukin‐10 (IL‐10), 30 which have been reported in EHS patients, 1 , 31 may be a potential mediator to down‐regulate mHLA‐DR level.…”

Section: Discussionmentioning

confidence: 99%

Monocyte HLA‐DR level on admission predicting in‐hospital mortality rate in exertional heatstroke: A 12‐year retrospective study

Wang,

Gong,

Shi

et al. 2024

Immunity Inflam & Disease

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BackgroundExertional heatstroke (EHS), a fatal illness, pronounces multiple organ dysfunction syndrome (MODS) and high mortality rate. Currently, no ideal factor prognoses EHS. Decreased monocyte human leukocyte‐DR antigen (mHLA‐DR) has been observed in critically ill individuals, particularly in those with sepsis. While most research focus on the pro‐inflammatory response exploration in EHS, there are few studies related to immunosuppression, and no report targeted on mHLA‐DR in EHS. The present study tried to explore the prognostic value of mHLA‐DR levels in EHS patients.MethodsThis was a single‐center retrospective study. Clinical data of EHS patients admitted to the intensive care unit of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed.ResultsSeventy patients with 54 survivors and 16 nonsurvivors were ultimately enrolled. Levels of mHLA‐DR in the nonsurvivors (41.8% [38.1–68.1]%) were significantly lower than those in the survivors (83.1% [67.6–89.4]%, p < 0.001). Multivariate logistic regression indicated that mHLA‐DR (odds ratio [OR] = 0.939; 95% confidence interval [CI]: 0.892–0.988; p = 0.016) and Glasgow coma scale (GCS) scores (OR = 0.726; 95% CI: 0.591–0.892; p = 0.002) were independent risk factors related with in‐hospital mortality rate in EHS. A nomogram incorporated mHLA‐DR with GCS demonstrated excellent discrimination and calibration abilities. Compared to the traditional scoring systems, the prediction model incorporated mHLA‐DR with GCS had the highest area under the curve (0.947, 95% CI: [0.865–0.986]) and Youden index (0.8333), with sensitivity of 100% and specificity of 83.33%, and a greater clinical net benefit.ConclusionPatients with EHS were at a risk of early experiencing decreased mHLA‐DR early. A nomogram based on mHLA‐DR with GCS was developed to facilitate early identification and timely treatment of individuals with potentially poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Monocyte HLA‐DR level on admission predicting in‐hospital mortality rate in exertional heatstroke: A 12‐year retrospective study

Wang,

Gong,

Shi

et al. 2024

Immunity Inflam & Disease

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“…In one, persistent cardiovascular failure and high serum cytokine levels, associated with a worse outcome, 39,[41][42][43] improved after the administration of hydrocortisone, and the patient was subsequently discharged home. 63 Similarly, out of five patients admitted with classical heatstroke, three were treated with blood purification therapy, who subsequently survived, while the two who only received conventional therapy died. 64 The study authors propose that the improved outcome was due to the removal of pro-inflammatory cytokines, 64 suggesting that glucocorticoids may have a similar effect.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of steroids in reducing morbidity and mortality from extreme hyperthermia and heatstroke—A systematic review

Walter

Gibson

2020

Pharmacology Res & Perspec

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Hyperthermia induces deleterious effects at the cellular, organ, and whole-body level, 1 and has a variety of causes, which include sepsis, classical and exertional heat illness, and drug-induced hyperthermia. While there is a survival benefit to a mild pyrexia in sepsis, 2,3 mortality increases as the core temperature (T CORE) exceeds 40°C, 2 suggesting that at higher temperatures, the deleterious effects on organ and cellular function outweigh any benefit conferred from pyrexia. In noninfective hyperthermia, however, a T CORE of 38.5°C or greater, is associated with a worse outcome. 3 Heatstroke represents the most severe form of heat illness with significant morbidity and mortality, including long-term multiorgan dysfunction and susceptibility to further heat illness. Exertional heatstroke (EHS) occurs in individuals undergoing strenuous physical activity, especially in hot and humid conditions, and is defined

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“…However, animal studies have been inconclusive on this issue and only isolated human case reports are concurrently available. 19…”

Section: Pathophysiologymentioning

confidence: 99%

A Case of Severe Heatstroke and Review of Pathophysiology, Clinical Presentation, and Treatment

Horseman

Rather-Conally

Saavedra

et al. 2012

J Intensive Care Med

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Heatstroke is life-threatening condition characterized by hyperthermia and central nervous system disturbances. It can also be classified as a form of systemic inflammatory response syndrome with multiple organ dysfunction and in many ways resembles sepsis. Like sepsis, most patients with heatstroke demonstrate a hyperdynamic hemodynamic response. In contrast to sepsis, rhabdomyolysis may complicate management and initial fluid resuscitation is not well defined. We present an illustrative case report and review of literature.

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Successful treatment with hydrocortisone for heat stroke with critical illness-related corticosteroid insufficiency: transitional changes in serum cytokine and cortisol concentrations

Cited by 5 publications

References 14 publications

Monocyte HLA‐DR level on admission predicting in‐hospital mortality rate in exertional heatstroke: A 12‐year retrospective study

Monocyte HLA‐DR level on admission predicting in‐hospital mortality rate in exertional heatstroke: A 12‐year retrospective study

The efficacy of steroids in reducing morbidity and mortality from extreme hyperthermia and heatstroke—A systematic review

A Case of Severe Heatstroke and Review of Pathophysiology, Clinical Presentation, and Treatment

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