Severe acute liver injury in patients with exertional heat stroke associated with poor short-term prognosis

Heat stroke is a potentially life-threatening condition characterized by a core temperature that exceeds the external temperature and is accompanied by central nervous system (CNS) abnormalities. It has two forms, classical heat stroke and exertional heat stroke (EHS). EHS is usually experienced by athletes, military personnel, and outdoor laborers in hot and humid environments. iven the need for physical training and some intrinsic and extrinsic risk factors, military personnel have a high chance of having exertional heat illness (EHI), which is an occupational hazard. The incidence of EHI ranges from 0.2 to 10.5 cases per 1,000 person-years among military personnel, and severe EHI is classified as EHS. In the United States Armed Forces, 4,188 cases of EHS were reported between 2008 and 2018, HS can lead to acute kidney injury (AKI), rhabdomyolysis, liver injury, and coagulation dysfunction and cause multiple organ dysfunction syndrome (MODS). Its pre-hospital treatment involves a timely escape from the thermal environment and rapid cooling therapy. Its common feature is mild to moderate liver injury, and liver function usually return to normal in 2-16 d. The clinical course of ALF is initiated by a SALI, which is characterized by the development of coagulopathy and impaired liver function but does not have any level of clinical hepatic encephalopathy (HE). 9 As a new definition, SALI can be considered the prophase of ALF, affecting the prognosis of patients with acute hepatitis. However, solid clinical research on the role of SALI in EHS remains lacking. In this study, we aimed to evaluate the clinical characteristics and 30-day outcomes of military personnel with SALI due to EHS.