Validation of a Score for the Detection of Subjects with High Risk for Severe High-Altitude Illness

Jean-Paul Richalet, Fabien Pillard, David LE Moal, Daniel Rivière, Philippe Oriol, Mathias Poussel, Bruno Chenuel, Stéphane Doutreleau, Samuel Vergès, Sophie Demanez, Michel Vergnion, Jean-Michel Boulet, Hervé Douard, Maryse Dupré, Olivier Mesland, Romain Remetter, Evelyne Lonsdorfer-Wolf, Alain Frey, Louis Vilcoq, Anne Nedelec Jaffuel, David Debeaumont, Guy Duperrex, François Lecoq, Christophe Hédon, Maurice Hayot, Guido Giardini, François J Lhuissier, Jean-Paul Richalet, Fabien Pillard, David LE Moal, Daniel Rivière, Philippe Oriol, Mathias Poussel, Bruno Chenuel, Stéphane Doutreleau, Samuel Vergès, Sophie Demanez, Michel Vergnion, Jean-Michel Boulet, Hervé Douard, Maryse Dupré, Olivier Mesland, Romain Remetter, Evelyne Lonsdorfer-Wolf, Alain Frey, Louis Vilcoq, Anne Nedelec Jaffuel, David Debeaumont, Guy Duperrex, François Lecoq, Christophe Hédon, Maurice Hayot, Guido Giardini, François J Lhuissier

Abstract

Purpose: A decision tree based on a clinicophysiological score (severe high-altitude illness (SHAI) score) has been developed to detect subjects susceptible to SHAI. We aimed to validate this decision tree, to rationalize the prescription of acetazolamide (ACZ), and to specify the rule for a progressive acclimatization.

Methods: Data were obtained from 641 subjects in 15 European medical centers before and during a sojourn at high altitude. Depending on the value of the SHAI score, advice was given and ACZ was eventually prescribed. The outcome was the occurrence of SHAI at high altitude as a function of the SHAI score, ACZ prescription, and use and fulfillment of the acclimatization rule.

Results: The occurrence of SHAI was 22.6%, similar to what was observed 18 yr before (23.7%), whereas life-threatening forms of SHAI (high-altitude pulmonary and cerebral edema) were less frequent (2.6%-0.8%, P = 0.007). The negative predictive value of the decision tree based was 81%, suggesting that the procedure is efficient to detect subjects who will not suffer from SHAI, therefore limiting the use of ACZ. The maximal daily altitude gain that limits the occurrence of SHAI was established at 400 m. The occurrence of SHAI was reduced from 27% to 12% when the recommendations for ACZ use and 400-m daily altitude gain were respected (P < 0.001).

Conclusions: This multicenter study confirmed the interest of the SHAI score in predicting the individual risk for SHAI. The conditions for an optimized acclimatization (400-m rule) were also specified, and we proposed a rational decision tree for the prescription of ACZ, adapted to each individual tolerance to hypoxia.

Copyright © 2020 by the American College of Sports Medicine.

References

    1. Bärtsch P, Swenson ER. Acute high-altitude illnesses. N Engl J Med . 2013;369:1666–7.
    1. Richalet JP, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological risk factors for severe high-altitude illness: a prospective cohort study. Am J Respir Crit Care Med . 2012;185:192–8.
    1. Canouï-Poitrine F, Veerabudun K, Larmignat P, Letournel M, Bastuji-Garin S, Richalet JP. Risk prediction score for severe high altitude illness: a cohort study. PLoS One . 2014;9:e100642.
    1. Richalet JP, Lhuissier FJ, Larmignat P, Canouï-Poitrine F. Evaluation de la tolérance à l’hypoxie et susceptibilité aux pathologies de haute altitude. Sci Sports . 2015;30:355–63.
    1. Richalet JP, Canouï-Poitrine F, Canou-Poitrine F, Larmignat P. Acute high-altitude illnesses. N Engl J Med . 2013;369:1664–5.
    1. Coustet B, Lhuissier FJ, Vincent R, Richalet JP. Electrocardiographic changes during exercise in acute hypoxia and susceptibility to severe high-altitude illnesses. Circulation . 2015;131:786–94.
    1. Winkler L, Lhuissier FJ, Richalet JP. Systemic blood pressure at exercise in hypoxia in hypertensive and normotensive patients. J Hypertens . 2017;35:2402–10.
    1. Richalet JP, Lhuissier FJ, Jean D. Ventilatory response to hypoxia and tolerance to high altitude in women: influence of menstrual cycle, oral contraception, and menopause. High Alt Med Biol . 2020;21:12–9.
    1. Swenson ER. Pharmacology of acute mountain sickness: old drugs and newer thinking. J Appl Physiol (1985) . 2016;120:204–15.
    1. Davis C, Hackett P. Advances in the prevention and treatment of high altitude illness. Emerg Med Clin North Am . 2017;35:241–60.
    1. Schmickl CN, Owens RL, Orr JE, Edwards BA, Malhotra A. Side effects of acetazolamide: a systematic review and meta-analysis assessing overall risk and dose dependence. BMJ Open Respir Res . 2020;7:e000557.
    1. Luks AM, Auerbach PS, Freer L, et al. Wilderness medical society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med . 2019;30:S3–18.
    1. Sutton JR, Coates G, Houston CS, editors. The Lake Louise consensus on the definition and quantification of altitude illness. In: Hypoxia and Mountain Medicine . Burlington: Queen City Printers Inc; 1992. pp. 327–30.
    1. Luks AM, Swenson ER. Travel to high altitude with pre-existing lung disease. Eur Respir J . 2007;29:770–92.
    1. Parati G, Agostoni P, Basnyat B, et al. Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: a joint statement by the European Society of Cardiology, the Council on Hypertension of the European Society of Cardiology, the European Society of Hypertension, the International Society of Mountain Medicine, the Italian Society of Hypertension and the Italian Society of Mountain Medicine. Eur Heart J . 2018;39:1546–54.
    1. Youden WJ. Index for rating diagnostic tests. Cancer . 1950;3:32–5.
    1. Duke CB, Sallade TD, Starling J, et al. Hypertension and acute mountain sickness in Himalayan trekkers in Nepal: an observational cohort study. Wilderness Environ Med . 2020;31:157–64.
    1. Lhuissier FJ, Canouï-Poitrine F, Richalet JP. Ageing and cardiorespiratory response to hypoxia. J Physiol . 2012;590:5461–74.
    1. Horiuchi M, Endo J, Akatsuka S, Uno T, Jones TE. Prevalence of acute mountain sickness on Mount Fuji: a pilot study. J Travel Med . 2016;23:taw024.
    1. Hackett PH, Rennie D, Levine HD. The incidence, importance, and prophylaxis of acute mountain sickness. Lancet . 1976;2:1149–55.
    1. Schneider M, Bernasch D, Weymann J, Holle R, Bartsch P. Acute mountain sickness: influence of susceptibility, preexposure, and ascent rate. Med Sci Sports Exerc . 2002;34:1886–91.
    1. Bloch KE, Turk AJ, Maggiorini M, et al. Effect of ascent protocol on acute mountain sickness and success at Muztagh Ata, 7546 m. High Alt Med Biol . 2009;10:25–32.
    1. Luks AM. Clinician’s corner: what do we know about safe ascent rates at high altitude? High Alt Med Biol . 2012;13:147–52.
    1. Richalet JP, Kéromès A, Dersch B, et al. Caractéristiques physiologiques des alpinistes de haute altitude. Sci Sports . 1988;3:89–108.
    1. Roach RC, Hackett PH, Oelz O, et al. The 2018 Lake Louise Acute Mountain Sickness Score. High Alt Med Biol . 2018;19:4–6.
    1. Richalet JP. Revisiting the Lake Louise score and its 2018 version. XII ISMM World Congress on Mountain Medicine Mountain Nov. 21–24, 2018 Kathmandu, Nepal. High Alt Med Biol . 2018;19:4045.
    1. Richalet JP, Larmignat P, Poignard P. Transient cerebral ischemia at high altitude and hyper-responsiveness to hypoxia. High Alt Med Biol . 2020;21:105–8.
    1. Keyes LE, Mather L, Duke C, et al. Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series. J Travel Med . 2016;23:taw052.
    1. Schommer K, Wiesegart N, Menold E, et al. Training in normobaric hypoxia and its effects on acute mountain sickness after rapid ascent to 4559 m. High Alt Med Biol . 2010;11:19–25.
    1. Wille M, Gatterer H, Mairer K, et al. Short-term intermittent hypoxia reduces the severity of acute mountain sickness. Scand J Med Sci Sports . 2012;22:e79–85.
    1. Fulco CS, Beidleman BA, Muza SR. Effectiveness of preacclimatization strategies for high-altitude exposure. Exerc Sport Sci Rev . 2013;41:55–63.
    1. Richalet JP, Canoui-Poitrine F. Pro: hypoxic cardiopulmonary exercise testing identifies subjects at risk for severe high altitude illnesses. High Alt Med Biol . 2014;15:315–7.
    1. Bärtsch P. Con: hypoxic cardiopulmonary exercise testing identifies subjects at risk for severe high altitude illnesses. High Alt Med Biol . 2014;15:318–20.

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