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Serum enzymes in heat stroke: prognostic implication
A H Alzeer1, M A el-Hazmi, A S Warsy
1Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Serum enzyme levels, including lactate dehydrogenase (LD), creatine kinase (CK), and aspartate aminotransferase (AST), can predict heat stroke (HS) survival. Higher enzyme levels indicate a poorer prognosis in HS patients.
Area of Science:
- Biochemistry
- Clinical Medicine
- Environmental Health
Background:
- Heat stroke (HS) is a severe hyperthermia condition.
- Elevated serum enzymes are observed in HS patients.
Purpose of the Study:
- To evaluate serum enzymes as prognostic indicators in heat stroke patients.
- To compare the prognostic value of serum enzymes with other clinical markers.
Main Methods:
- Serum creatine kinase (CK), lactate dehydrogenase (LD), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were measured in 26 heat stroke victims and 10 controls.
- Patients were categorized into quick recovery, critically ill, and deceased groups.
- Receiver Operating Characteristic (ROC) curves were used to assess prognostic accuracy.
Main Results:
- Serum enzymes (CK, AST, ALT, LD) were significantly higher in HS victims compared to controls upon admission.
- Non-survivors and critically ill patients had significantly higher admission serum enzyme levels than those with quick recovery.
- Lactate dehydrogenase (LD) demonstrated the highest prognostic accuracy (AUC = 0.991), followed by CK and AST.
- Serum enzyme levels were superior prognostic indicators compared to body temperature, anion gap, and serum potassium.
Conclusions:
- Serum enzyme levels, particularly LD, CK, and AST, are valuable prognostic markers for heat stroke outcomes.
- These biochemical markers can aid in identifying patients at higher risk of mortality or severe illness.
Abstract:
We measured serum creatine kinase (CK), lactate dehydrogenase (LD), aspartate aminotransferase (AST), and serum alanine aminotransferase (ALT) in 26 heat stroke (HS) victims and 10 control (non-heat-exhausted) subjects during annual Hajj in Makkah, Saudi Arabia. On admission to the HS treatment unit, serum CK, AST, ALT, and LD were higher in HS victims than controls (P < 0.05), and at 6, 12, and 24 h were higher than baseline concentration. The patient group was divided into three groups, (a) those who had a quick recovery, (b) those who were critically ill until the end of the Hajj period (7 days), and (c) those who died. Serum enzymes at the time of admission were significantly higher (P < 0.05) in the nonsurviving group (n = 6) and the severely ill (n = 9) than in those who had a quick recovery (n = 11). ROC curves were plotted for each enzyme. The most useful indicator was LD, as it could distinguish significantly between the groups who died and those who had a quick recovery (area under the curve = 0.991 +/- 0.0286). It was followed by CK and AST as useful prognostic factors. When compared with ROC curves for body temperature, anion gap, and serum potassium, the enzyme results were superior prognostic indicators.