Abstract: Objective To analyze the early diagnosis and treatment data of patients with heat stroke,clarify the early warning indicators and high risk factors of death,and optimize the clinical management strategy of heat stroke. Methods A real-world study was conducted to collect the clinical data of patients with heat stroke admitted to the emergency department and intensive care unit of a regional central hospital from January 1,2017 to December 31,2023. The differences in early clinical characteristics between the survival group and the death group were analyzed. Multivariate logistic regression analysis was used to identify the high risk factors for the poor prognosis of heat stroke,and the receiver operating characteristic curve was used to verify its predictive efficacy. Blood samples were collected from some patients when they entered the room to obtain plasma,and the luminex kit was used to detect the content of inflammatory factors and pro-inflammatory factors. Results A total of 85 patients with heat stroke were enrolled in this study,including 53 cases(62.35%) of exertional heat stroke and 32 cases(37.65%) of classical heat stroke,mainly concentrated in July and August(90.58%),and the 90-day mortality rate was 28.23%. The recent gastrointestinal infection rate,lactic acid,prothrombin time(PT),activated partial prothrombin time(APTT),procalcitonin(PCT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),blood urea nitrogen(BUN) and creatinine in the death group were significantly higher than those in the survival group(all P<0.05). Multivariate logistic regression analysis showed that recent gastrointestinal infection,high lactic acid,BUN and PCT were independent risk factors for poor prognosis in patients with heat stroke. Pre-onset gastrointestinal infection increased the risk of death in patients with heat stroke(OR=7.184,95%CI：1.023-50.460,P<0.05). Plasma levels of inflammatory factors(TNF-α,IL-1ra and IL-6),chemokines(CCL2,CXCL8,CXCL10 and GM-CSF) and liver and kidney injury markers were significantly higher in patients with pre-onset gastrointestinal infection than in those with normal gastrointestinal function(all P<0.05). Conclusion High levels of plasma lactic acid,PCT and BUN in patients with early disease are high risk factors for death of heat stroke,and the combined detection of the three has high efficiency. In patients with intestinal infection before onset,elevated plasma inflammatory factors in the early stage of the disease lead to liver and kidney inflammatory injury,which significantly increases the risk of death. This study can guide clinicians to quickly identify patients with severe heat stroke in the early stage of the disease,which is helpful to improve the prognosis.

Key words: Heat stroke, Clinical characteristics, High risk factors, Intestinal infections, Real world study