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

Table 1 Clinical characteristics, laboratory findings at admission, gastrointestinal symptoms findings, complications, treatments, and clinical outcomes of the study patients, according to developed gastrointestinal symptoms or not¹

	All Patients, (n = 713)	GI Symptoms whether2		P value
		Yes (n = 132)	No (n = 581)
Characteristic
Age, median (IQR), yr	72.0 (64.0-80.0)	70.0 (59.0-76.0)	73.0 (64.0-81.0)	0.076
Distribution, n (%)
0-39 yr	13 (1.8)	1 (0.01)	12 (2.1)	—
40-59 yr	132 (18.5)	32 (24.2)	100 (17.2)	—
60-79 yr	371 (52.0)	73 (55.3)	298 (51.2)	—
≥ 80 yr	197 (27.6)	26 (19.6)	171 (29.4)	—
Female sex	332 (46.6)	60 (45.4)	272 (46.8)	0.561
BMI, median (IQR), kg/m2	22.1 (20.3-24.2)	22.5 (20.0-24.6)	22.0 (20.3-24.1)	0.875
GCS score at ICU admission, median (IQR)	6.0 (4.0-9.0)	5.0 (3.0-7.0)	6.0 (4.0-9.0)	0.018
NRS-2002 score at ICU admission, median (IQR)	4.0 (3.0-5.0)	3.0 (3.0-5.0)	4.0 (3.0-5.0)	0.014
Body temperature on admission
Patients, n (%)	710 (99.1)	132 (100.0)	578 (98.8)	0.374
Temperature, median (IQR), °C	40.7 (40.0-41.3)	41.0 (40.1-42.0)	40.5 (40.0-41.2)	< 0.001
Heat exposure duration, median (IQR), h	4.0 (2.0-6.0)	4.0 (2.0-6.0)	4.0 (2.0-6.3)	0.206
Distribution of body temperature on admission, n (%)
< 37.3 °C	6 (1.0)	0 (0.0)	6 (0.1)	—
37.3–38.0 °C	13 (2.1)	1 (0.8)	12 (2.3)	—
38.1–39.0 °C	59 (9.3)	8 (6.7)	51 (9.9)	—
39.1–40.0 °C	175 (27.7)	33 (27.7)	142 (27.7)	—
> 40.0 °C	379 (60.0)	77 (64.7)	302 (58.9)	—
Number of complaints and symptoms on admission, n (%)
< 2	169/672 (25.1)	27/126 (21.4)	142/546 (26.3)	0.053
2-3	348/672 (51.8)	47/126 (37.3)	301/546 (55.1)	0.094
> 3	155/672 (23.1)	52/126 (41.3)	103/546 (18.9)	< 0.001
Complaints and symptoms on admission, n (%)
Fever	476 (66.8)	93 (70.5)	383 (65.9	0.272
Altered mental state or behavior	343 (48.1)	55 (41.7)	288 (49.6	0.177
Dry skin or excessive sweating	65 (9.1)	20 (15.1)	45 (7.7)	< 0.001
Rubefaction	32 (4.5)	11 (8.3)	21 (3.6)	0.035
Fast pulse	142 (19.9)	40 (30.3)	102 (17.5	< 0.001
Polypnea	175 (24.5)	38 (38.7)	137 (23.6)	0.019
Headache	15 (2.1)	3 (2.3)	12 (2.1)	0.438
Syncope	309 (43.3)	85 (64.4)	224 (38.6)	< 0.001
Other	102 (14.3)	27 (20.5)	75 (12.9)	0.013
Coexisting disorder, n (%)
Diabetes	87 (12.2)	10 (7.6)	77 (13.3)	0.225
Hypertension	187 (26.2)	36 (27.3)	151 (26.0)	0.985
Chronic obstructive pulmonary disease	124 (17.4)	21 (15.9)	103 (17.7)	0.697
Chronic cardiac insufficiency	79 (11.1)	16 (12.1)	63 (10.8)	0.541
Hepatitis B infection	14 (2.0)	1 (0.8)	13 (2.2)	0.488
Cancer3	5 (0.7)	3 (2.3)	2 (0.3)	0.033
Chronic renal disease	17 (2.4)	2 (1.5)	15 (2.6)	0.149
Immunodeficiency	9 (1.3)	3 (2.3)	6 (1.0)	0.965
Laboratory findings, median (IQR)
PaO2/FiO2 ratio	239.0 (174.0-323.0)	238.0 (185.5-300.5)	248.0 (190.0-336.0)	0.064
White-cell count, 109/L	11.7 (8.2-15.5	10.0 (6.6-14.4),	11.7 (8.4-15.5)	0.032
Lymphocyte count, 109/L	1.3 (0.7-2.4)	0.9 (0.5-2.3)	1.0 (0.6-2.1)	0.746
Platelet count, 109/L	108.0 (73.0-162.0)	84.0 (45.0-115.0)	110.0 (75.0-165.5)	0.147
Hemoglobin, g/L	123 (109-138)	115 (102-127)	124 (109-138)	0.014
Albumin, g/L	37.0 (33.2-40.2)	33.4 (29.1-43.8)	37.0 (33.3-40.3)	0.014
Other findings, median (IQR)
C-reactive protein, mg/L	5.0 (1.0-11.8)	11.9 (5.1-32.1)	5.0 (1.0-12.0)	0.005
Procalcitonin, ng/mL	2.7 (0.5-13.1)	3.2 (0.4-8.9)	2.8 (0.5-12.6)	0.593
Lactate dehydrogenase, U/L	367.9 (284.8-547.5)	327.0 (273.0-507.4)	362.5 (281.8-524.0)	0.667
Aspartate aminotransferase, U/L	79.0 (40.9-191.0)	115.9 (51.3-269.8)	74.0 (39.3-168.8)	0.128
Alanine aminotransferase, U/L	38.0 (21.0-85.0)	48.0 (28.1-104.1)	36.0 (20.0-77.3)	0.479
Total bilirubin, μmol/L	17.9 (12.5-25.7)	18.2 (11.8-258.9),	17.9 (12.5-25.9)	0.186
CK-Mb, U/L	10.0 (2.8-32.0)	13.6 (4.2-74.6)	9.9 (2.7-31.7)	0.539
Creatinine, μmol/L	125.0 (89.8-169.2)	122.0 (84.0-162.	123.0 (88.4-169.2)	0.944
D-dimer, mg/L	4.6 (1.8-12.9)	4.1 (2.1-8.6)	4.7 (1.7-12.8)	0.561
Minerals, median (IQR), mmol/L
Sodium	133.3 (129.0-139.0)	136.0 (132.0-140.0)	133.6 (129.0-139.0)	0.158
Potassium	3.2 (2.9-3.8)	3.6 (3.0-3.9)	3.2 (2.9-3.8)	0.043
Lactate	3.5 (2.1-5.1)	3.1 (1.6-4.1)	3.4 (2.0-5.1)	0.036
GI symptoms findings, n (%)
Duration of GI symptoms, median (IQR), d	—	4.0 (2.0-7.0)	—	—
Diarrhea	—	99 (75.0)	—	—
Flatulence	—	36 (27.3)	—	—
Nausea/vomiting	—	21 (15.9)	—	—
Bloody stools	—	8 (6.1)	—	—
Complications, n (%)
Number of complications
< 2	263 (36.9)	28 (21.1)	235 (38.8)	0.002
2-3	133 (18.7)	12 (9.2)	121 (19.8)	0.025
> 3	317 (44.5)	92 (69.7)	225 (41.4)	< 0.001
Disturbance of water and electrolyte	412 (57.8)	95 (72.0)	317 (54.6)	0.013
Rhabdomyolysis	102 (14.3)	34 (25.8)	68 (11.7)	0.004
Myocardial damage	281 (39.4)	70 (53.0)	211 (36.3)	< 0.001
Disseminated intravascular coagulation	221 (31.0)	62 (46.9)	159 (27.4)	0.006
Acute respiratory distress syndrome	256 (35.9)	66 (50.0)	190 (32.7)	0.001
Acute kidney injury	299 (41.9)	83 (62.9)	216 (37.2)	0.003
Acute liver function impairment	305 (42.8)	81 (61.4)	224 (38.6)	< 0.001
Central nervous system damage	256 (35.9)	74 (56.1)	182 (31.9)	0.003
Treatments, n (%)
Mechanical ventilation
Invasive	439 (61.7)	108 (82.6)	331 (57.1)	< 0.001
Noninvasive	10 (1.4)	0 (0.0)	10 (1.6)	0.271
Use of continuous renal-replacement therapy	24 (3.4)	7 (9.2)	17 (2.7)	0.003
Length of ICU stay, median (IQR), d	2.0 (1.0-4.0)	4.0 (2.0-7.0)	2.0 (1.0-3.0)	0.001
Clinical outcomes at data cutoff, n (%)
Hospital discharge	349 (48.9)	64 (48.5)	285 (49.1)	0.906
Death	144 (20.2)	26 (19.7)	118 (20.3)	0.874
Still hospitalization	187 (26.2)	33 (25.0)	154 (26.5)	0.723
Transferred to another hospital	33 (4.6)	9 (6.8)	24 (4.1)	< 0.001

¹The denominators of patients who were included in the analysis are provided if they differed from the overall numbers in the group. Percentages may not total 100 because of rounding.

²Nausea/vomiting, diarrhea, flatulence, or bloody stools are defined as gastrointestinal symptoms.

³Included in this category is any type of cancer.

IQR: Interquartile range; GCS: Glasgow coma scale; NRS: Nutrition risk screening; GI: Gastrointestinal; BMI: Body mass index; ICU: Intensive care unit; CK-Mb: Creatine kinase.