Age-leukocyte-international normalized ratio score (ALIS): A bedside triparametric tool for neurological prognostication in heat stroke emergencies.

OBJECTIVE

This study was to develop and validate the age-leukocyte-international normalized ratio score (ALIS), a novel triparametric prognostic tool integrating geriatric vulnerability, systemic inflammation, and consumptive coagulopathy, to predict neurological outcomes in heat stroke (HS) patients.

METHODS

This retrospective, multicenter study was performed to establish a novel scoring system based on age, inflammation indicators and coagulation test results, with a validation cohort employed to verify the reliability. The primary endpoint was neurological prognosis at discharge, and secondary endpoint included multiple organ dysfunction syndrome, requirement for mechanical ventilation, continuous renal replacement therapy, admission to the intensive care unit, and death at discharge. Prognostic discrimination capacity was evaluated using receiver operating characteristic curve analysis with Delong's test to compare the performance against quick Sequential Organ Failure Assessment (qSOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores.

RESULTS

Overall, 235 patients with HS were recruited, and allocated to the derivation (n = 165) and validation (n = 70) cohort at a ratio of 7:3. In the derivation cohort, 36 patients had poor outcomes post-discharge. Multivariate regression analysis identified age, leukocyte count, and international normalized ratio as independent risk factors predicting poor outcomes, which were used to construct the new scoring system (ALIS). In the derivation and validation cohort, the ability of ALIS(AUC = 0.817, 0.820, respectively) to predict poor outcome was similar to qSOFA(AUC = 0.812, 0.680, respectively) and APACHE II (AUC = 0.802, 0.762, respectively). However, the assessment of ALIS was quicker and simpler than APACHE II. Among patients with HS, those with ALIS >2 had a significantly higher incidence of adverse outcome than those with ALIS ≤2.

CONCLUSION

The ALIS is a clinically implementable decision-support tool that significantly outperforms conventional severity scores in bedside prognostication of HS outcomes. Its zero-cost computation and bedside applicability make it particularly suited for resource-constrained emergency settings.