In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 2 ( 2022-2-17), p. e0263873-
Abstract:
Medical personnel may find it challenging to distinguish severe Exertional Heat Illness (EHI), with attendant risks of organ-injury and longer-term sequalae, from lesser forms of incapacity associated with strenuous physical exertion. Early evidence for injury at point-of-incapacity could aid the development and application of targeted interventions to improve outcomes. We aimed to investigate whether biomarker surrogates for end-organ damage sampled at point-of-care (POC) could discriminate EHI versus successful marathon performance. Methods Eight runners diagnosed as EHI cases upon reception to medical treatment facilities and 30 successful finishers of the same cool weather marathon (ambient temperature 8 rising to 12 ºC) were recruited. Emerging clinical markers associated with injury affecting the brain (neuron specific enolase, NSE; S100 calcium-binding protein B, S100β) and renal system (cystatin C, cysC; kidney-injury molecule-1, KIM-1; neutrophil gelatinase-associated lipocalin, NGAL), plus copeptin as a surrogate for fluid-regulatory stress, were sampled in blood upon marathon collapse/completion, as well as beforehand at rest (successful finishers only). Results Versus successful finishers, EHI showed significantly higher NSE (10.33 [6.37, 20.00] vs. 3.17 [2.71, 3.92] ug.L -1 , P 〈 0.0001), cysC (1.48 [1.10, 1.67] vs. 1.10 [0.95, 1.21] mg.L -1 , P = 0.0092) and copeptin (339.4 [77.0, 943] vs. 18.7 [7.1, 67.9] pmol.L -1 , P = 0.0050). Discrimination of EHI by ROC (Area-Under-the-Curve) showed performance that was outstanding for NSE (0.97, P 〈 0.0001) and excellent for copeptin (AUC = 0.83, P = 0.0066). Conclusions As novel biomarker candidates for EHI outcomes in cool-weather endurance exercise, early elevations in NSE and copeptin provided sufficient discrimination to suggest utility at point-of-incapacity. Further investigation is warranted in patients exposed to greater thermal insult, followed up over a more extended period.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0263873
DOI:
10.1371/journal.pone.0263873.g001
DOI:
10.1371/journal.pone.0263873.g002
DOI:
10.1371/journal.pone.0263873.g003
DOI:
10.1371/journal.pone.0263873.t001
DOI:
10.1371/journal.pone.0263873.s001
DOI:
10.1371/journal.pone.0263873.s002
DOI:
10.1371/journal.pone.0263873.s003
DOI:
10.1371/journal.pone.0263873.s004
DOI:
10.1371/journal.pone.0263873.s005
DOI:
10.1371/journal.pone.0263873.r001
DOI:
10.1371/journal.pone.0263873.r002
DOI:
10.1371/journal.pone.0263873.r003
DOI:
10.1371/journal.pone.0263873.r004
DOI:
10.1371/journal.pone.0263873.r005
DOI:
10.1371/journal.pone.0263873.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3