Indicators of Acute Kidney Injury as Biomarkers to Differentiate Heatstroke from Coronavirus Disease 2019: A Retrospective Multicenter Analysis

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  • Obinata Hirofumi
    Department of Emergency and Critical Care Medicine, Nippon Medical School Self-Defense Forces Central Hospital
  • Yokobori Shoji
    Department of Emergency and Critical Care Medicine, Nippon Medical School Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee
  • Ogawa Kei
    Department of Industrial Administration, Tokyo University of Science
  • Takayama Yasuhiro
    Department of Emergency Medicine, Flowers & Forest Tokyo Hospital
  • Kawano Shuichi
    Self-Defense Forces Central Hospital
  • Ito Toshimitsu
    Self-Defense Forces Central Hospital
  • Takiguchi Toru
    Department of Emergency and Critical Care Medicine, Nippon Medical School
  • Igarashi Yutaka
    Department of Emergency and Critical Care Medicine, Nippon Medical School
  • Nakae Ryuta
    Department of Emergency and Critical Care Medicine, Nippon Medical School
  • Masuno Tomohiko
    Department of Emergency and Critical Care Medicine, Nippon Medical School
  • Ohwada Hayato
    Department of Industrial Administration, Tokyo University of Science

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<p>Background: Coronavirus disease 2019 (COVID-19) and heat-related illness are systemic febrile diseases. These illnesses must be differentiated during a COVID-19 pandemic in summer. However, no studies have compared and distinguished heat-related illness and COVID-19. We compared data from patients with early heat-related illness and those with COVID-19. Methods: This retrospective observational study included 90 patients with early heat-related illness selected from the Heatstroke STUDY 2017-2019 (nationwide registries of heat-related illness in Japan) and 86 patients with laboratory-confirmed COVID-19 who had fever or fatigue and were admitted to one of two hospitals in Tokyo, Japan. Results: Among vital signs, systolic blood pressure (119 vs. 125 mm Hg, p = 0.02), oxygen saturation (98% vs. 97%, p < 0.001), and body temperature (36.6°C vs. 37.6°C, p<0.001) showed significant between-group differences in the heatstroke and COVID-19 groups, respectively. The numerous intergroup differences in laboratory findings included disparities in white blood cell count (10.8 × 103/μL vs. 5.2 × 103/μL, p<0.001), creatinine (2.2 vs. 0.85 mg/dL, p<0.001), and C-reactive protein (0.2 vs. 2.8 mg/dL, p<0.001), although a logistic regression model achieved an area under the curve (AUC) of 0.966 using these three factors. A Random Forest machine learning model achieved an accuracy, precision, recall, and AUC of 0.908, 0.976, 0.842, and 0.978, respectively. Creatinine was the most important feature of this model. Conclusions: Acute kidney injury was associated with heat-related illness, which could be essential in distinguishing or evaluating patients with fever in the summer during a COVID-19 pandemic.</p>

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  • 日医大誌

    日医大誌 88 (1), 80-86, 2021-02-15

    日本医科大学医学会

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