Sex Differences in Biomarkers of End-Organ Damage following Exertional Heat Stroke in Humans

Women are participating in military and athletic activities in the heat in increasing numbers, but potential sex differences in sequelae from exertional heat illness remain poorly understood. We tested the hypothesis that women suffering from exertional heat stroke (EHS) would have similar severity of organ damage biomarkers compared to men, as measured in a hospital setting. We studied women and men presenting with EHS to the emergency department at Fort Moore, GA. We measured creatinine (CR), creatine kinase (CK), alanine-transaminase (ALT), aspartate aminotransferase (AST), and estimated glomerular filtration rate (eGFR). Core temperature was also assessed by medical personnel. Biomarker data were obtained for 62 EHS cases (11 women). Men were significantly taller, and heavier, had larger BMI and body surface area (p<0.05 for all). Highest recorded body core temperature was not different between groups (women: 41.11°C (40.06,41.67); men: 41.11°C (40.28,41.72), p=0.57). Women had significantly lower peak CR (women: 1.39 (1.2,1.48) mgꞏdL -1 ; men: 1.75 (1.53,2.16) mgꞏdL -1 , p<0.01) and peak CK (women: 584 (268,2412) UꞏL -1 ; men: 2183 (724,5856) U•L -1 , p=0.02). Peak ALT and AST were not different between groups; during recovery time points, ALT and AST were either similar or lower in women. Women spent approximately half as much time in the hospital following admittance compared to men. Our findings suggest that women may be less susceptible to organ injury resulting from EHS. Further research is necessary to understand the pathophysiology underlying these differences and how biomarkers of end-organ damage severity can differ between women and men following EHS.