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Serum enzymes in heat stroke: prognostic implication

¹ Department of Medicine and
² Department of Biochemistry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

³ Department of Medicine, King Faisal Hospital, Makkah, Saudi Arabia.
^a Address correspondence to this author at: King Khalid University Hospital, P.O. Box 18321, Riyadh 11415, Saudi Arabia. Fax (966) (1) 467-9495.

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.

Key Words: indexing terms: creatine phosphokinase • lactate dehydrogenase • aspartate aminotransferase • alanine aminotransferase • receiver-operating characteristic plots

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