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Laurent Argaud, MD, PhD; Tristan Ferry, MD; Quoc-Hung Le, MD; Aurélia Marfisi, MD; Diana Ciorba, MD; Pierre Achache, MD; Roland Ducluzeau, MD; Dominique Robert, MD

Arch Intern Med. 2007;167(20):2177-2183. Published online August 13, 2007 (doi:10.1001/archinte.167.20.ioi70147).

Background  During August 2003, Europe sustained a severe heat wave that resulted in 14 800 heat-related deaths in France. Most of these excess deaths occurred in urban areas, where maximal temperatures broke all records. Heatstroke is the most severe form of heat-related illness. The clinical course of heatstroke in urban areas of temperate countries is poorly documented.

Methods  During the French heat wave (August 1-20, 2003), we conducted a prospective study in a university hospital located in Lyon, one of the largest metropolitan areas in France. We evaluated survival and functional outcome for 2 years and looked for factors influencing the prognosis.

Results  A total of 83 patients presented with heatstroke. The 28-day and 2-year mortality rates were 58% and 71%, respectively. Mortality was influenced as early as admission by the level of fever and the number of organ dysfunctions. Multivariate analysis revealed an independent contribution to mortality if patients came from an institution (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.05-3.71), used long-term antihypertensive medication (HR, 2.17; 95% CI, 1.17-4.05), or presented at admission with anuria (HR, 5.24; 95% CI, 2.29-12.03), coma (HR, 2.95; 95% CI, 1.26-6.91), or cardiovascular failure (HR, 2.43; 95% CI, 1.14-5.17). Most surviving patients exhibited a dramatic alteration of their functional status at 1 and 2 years.

Conclusions  Heatstroke is associated with poor outcomes in temperate urban areas. This could be explained at least in part by our lack of experience. Western temperate countries need to be more prepared for future heat waves.

Author Affiliations: Pôle d'activité d'Urgence et Réanimation Médicales, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, and Lyon-Nord Medical School, University Claude Bernard Lyon I, Lyon, France (Drs Argaud, Ferry, Marfisi, Ciorba, Achache, Ducluzeau, and Robert); and Département de Biostatistiques, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France (Dr Le).

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