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

Jean-Paul Richalet (1, 2) , Fabien Pillard (3, 4) , David Le Moa (2) , Daniel Rivière (3, 4) , Philippe Oriol (5) , Mathias Poussel (6) , Bruno Chenuel (6) , Stephane Doutreleau (7, 8) , Samuel Verges (7, 8) , Sophie Demanez (9) , Michel Vergnion (9) , Jean-Michel Boulet (10) , Herve Douard (10) , Maryse Dupré (11) , Olivier Mesland (11) , Romain Remetter (12) , Evelyne Lonsdorfer-Wolf (12) , Alain Frey (13) , Louis Vilcoq (13) , Anne Nedelec-Jaffuel (13) , David Debeaumont (14) , Guy Duperrex (15) , François Lecoq (15) , Christophe Hédon (16, 17) , Maurice Hayot (16, 17) , Guido Giardini (18) , François J. Lhuissier (2, 19)

1 INSEP - Institut national du sport, de l'expertise et de la performance
2 H&P - U1272 Inserm - Hypoxie et Poumon : pneumopathologies fibrosantes, modulations ventilatoires et circulatoires
3 I2MC - Institut des Maladies Métaboliques et Cardiovasculaires
4 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
5 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
6 DevAH - Développement, Adaptation et Handicap. Régulations cardio-respiratoires et de la motricité
7 HP2 - Hypoxie et PhysioPathologie
8 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
9 Centre de physiologie de l'effort - CB Move [Herve]
10 CHU Bordeaux
11 CHU Nantes - Centre Hospitalier Universitaire de Nantes
12 Nouvel Hôpital Civil de Strasbourg
13 CHI Poissy-Saint-Germain
14 CIC Rouen - Centre d'Investigation Clinique [CHU Rouen]
15 Hôpitaux du Pays du Mont-Blanc
16 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
17 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
18 Ospedale regionale Umberto Parini [Aosta]
19 Hôpital Jean Verdier [AP-HP]

Purpose: A decision tree based on a clinico-physiological score (SHAI score) has been developed to detect subjects susceptible to Severe High Altitude Illness (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 SHAI score, advice was given and ACZ was eventually prescribed. The outcome was the occurrence of SHAI at high altitude as a function of 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 years before (23.7%), while life-threatening forms of SHAI (High Altitude Pulmonary and Cerebral Edema) were less frequent (2.6% to 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).Conclusion: 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 acetazolamide, adapted to each individual tolerance to hypoxia

Domaines: Sciences du Vivant [q-bio]

Jean-Paul Richalet, Fabien Pillard, David Le Moa, Daniel Rivière, Philippe Oriol, et al.. Validation of a Score for the Detection of Subjects with High Risk for Severe High-Altitude Illness. Medicine and Science in Sports and Exercise, 2021, 53 (6), pp.1294-1302. ⟨10.1249/MSS.0000000000002586⟩. ⟨hal-03108569⟩