{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:52:43Z","timestamp":1793055163705,"version":"4.5.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science KAKENHI","doi-asserted-by":"crossref","award":["JP19K18365"],"award-info":[{"award-number":["JP19K18365"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the \u201csevere\u201d group or the \u201cmild-to-moderate\u201d group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received \u201cactive cooling + rehydration\u201d and patients who received \u201crehydration only,\u201d with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21\u20138.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92\u20135.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.<\/jats:p>","DOI":"10.1371\/journal.pone.0259441","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T18:34:46Z","timestamp":1637174086000},"page":"e0259441","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6328-8732","authenticated-orcid":true,"given":"Jun","family":"Kanda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Nakahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasufumi","family":"Miyake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiki","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoji","family":"Yokobori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arino","family":"Yaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Sakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"pone.0259441.ref001","doi-asserted-by":"crossref","first-page":"173","DOI":"10.7326\/0003-4819-129-3-199808010-00001","article-title":"Near-fatal heat stroke during the 1995 heat wave in Chicago","volume":"129","author":"JE Dematte","year":"1998","journal-title":"Ann Intern Med"},{"key":"pone.0259441.ref002","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2807\/esm.10.07.00554-en","article-title":"Summary of the mortality impact assessment of the 2003 heat wave in France","volume":"10","author":"P Pirard","year":"2005","journal-title":"EURO Surveill"},{"key":"pone.0259441.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1476-069X-14-11","article-title":"Impact of the 2011 heat wave on mortality and emergency department visits in Houston, Texas","volume":"14","author":"K Zhang","year":"2015","journal-title":"Environ Health"},{"key":"pone.0259441.ref004","doi-asserted-by":"crossref","first-page":"37294","DOI":"10.1038\/srep37294","article-title":"Heat stroke internet searches can be a new heatwave health warning surveillance indicator","volume":"6","author":"T Li","year":"2016","journal-title":"Sci Rep"},{"key":"pone.0259441.ref005","first-page":"6219236","article-title":"Heat stroke: A medical emergency appearing in new regions","volume":"2017","author":"SS Morch","year":"2017","journal-title":"Case Rep Crit Care"},{"issue":"Pt A","key":"pone.0259441.ref006","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.envpol.2016.10.008","article-title":"Heatwave and risk of hospitalization: A multi-province study in Vietnam","volume":"220","author":"D Phung","year":"2017","journal-title":"Environ Pollut"},{"key":"pone.0259441.ref007","doi-asserted-by":"crossref","first-page":"h3477","DOI":"10.1136\/bmj.h3477","article-title":"Pakistan authorities trade blame as heatwave deaths exceed 800","volume":"350","author":"J Clark","year":"2015","journal-title":"BMJ"},{"key":"pone.0259441.ref008","unstructured":"Fire and Disaster Management Agency of Japan. 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