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This retrospective, multicentre study enrolled 143 patients admitted to the emergency department and diagnosed with heat stroke. The primary outcome was the in-hospital mortality rate, while secondary outcomes included the presence and number of damaged organs and neurological sequelae at discharge. A body temperature curve was built using a generalized additive mixed model, and the association between body temperatures and outcomes was established by logistic regression. The threshold and saturation effects were used to explore the targeted body temperature management. Cases were divided into the surviving and non-surviving groups. The cooling rate within the first 2\u00a0h was significantly higher in the survival group than the non-survival group (\u03b2: 0.47; 95% confidence interval [CI]: 0.09\u20130.84; <jats:italic>P<\/jats:italic>\u2009=\u20090.014), while the non-survival group exhibited a lower body temperature within 24\u00a0h (\u03b2: \u2212\u00a00.06; 95% CI: \u2212\u00a00.08 to \u2212\u00a00.03; <jats:italic>P<\/jats:italic>\u2009\u2264\u20090.001). Body temperature after 2\u00a0h (odds ratio [OR]: 2.27; 95% CI: 1.14\u20134.50; <jats:italic>P<\/jats:italic>\u2009=\u20090.019) and lowest temperature within 24\u00a0h (OR: 0.18; 95% CI: 0.06\u20130.55; <jats:italic>P<\/jats:italic>\u2009=\u20090.003) were significantly related to in-hospital mortality rate. When the body temperature at 0.5\u00a0h was 38.5\u201340.0\u00a0\u00b0C, the number of damaged organs was at its lowest. In patients with heat stroke, both hyperthermia and hypothermia were associated with adverse outcomes. 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