Early changes in liver function and their prognostic value in patients with exertional heat stroke / 解放军医学杂志

ABSTRACT

Objective To explore the early changes in liver function and their prognostic value in patients with exertional heat stroke (EHS). Methods The clinical data of sixty-nine patients with EHS admitted to 10 military hospitals from 2005 to 2013 were retrospectively analyzed. Among them 57 survived and 12 died. The levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) in the first 10 days after the onset of heat stroke were detected. The receiver operating characteristic (ROC) curve was ploted to assess the prognostic value of the worst value of various parameters in patients with EHS. Results Serum aminotransferase reached the peak 3 to 4 days after onset of EHS, and then it began to decline, and serum bilirubin reached the peak 5 to 8 days after the onset, and then it began to decline slowly. Te relevant liver function indicators in death group were higher than those in survival group at corresponding days. Early onset of serum transaminases and bilirubin was found to have a high prognostic value, and the total area under the ROC curves of ALT for death judgment was 0.833 ± 0.064, with the best diagnostic point as 3016.5U/L. The total area under the ROC curves of AST for death judgment was 0.798 ± 0.073, and the best diagnostic point was 4745U/L. Te total area under the ROC curves of TBIL for death judgment was 0.810 ± 0.067, and the best diagnostic point was 123.9μJLmol/L. Te total area under the ROC curves of DBIL for death judgment was 0.836 ± 0.063, and the best diagnostic point was 87.42μxmol/L. Conclusions The changes in liver function at early stage of EHS onset show certain regularity. Te worst value of relevant liver function indicators has a high predictive value for the severity of the ailment and its prognosis, and the findings remind us to pay more atention to the risk of death when the value of liver function test reaches or higher than the best diagnostic level.