Abnormal shock index exposure and clinical outcomes among critically ill patients: A retrospective cohort analysis

Maheshwari, Kamal; Nathanson, Brian H.; Munson, Sibyl H.; Hwang, Seungyoung; Yapici, Halit O; Stevens, Mitali; Ruiz, Carlos A. Jiménez; Hunley, Charles

doi:10.1016/j.jcrc.2020.01.024

Cited by 17 publications

(15 citation statements)

References 31 publications

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“…The SI has been used to predict mortality in patients with medical conditions ( 7 ), such as sepsis ( 8 , 9 ), pulmonary embolism ( 10 ), and community-acquired pneumonia ( 11 ). Furthermore, changes in SI values over time predict mortality in non-traumatic critically ill patients ( 12 , 13 ). In the pediatric population, the SI can also be useful in predicting mortality in children with septic shock ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Huang

Yang

et al. 2021

Front. Pediatr.

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Background: The shock index, pediatric age-adjusted (SIPA), defined as the maximum normal heart rate divided by the minimum normal systolic blood pressure by age, can help predict the risk of morbidity and mortality after pediatric trauma. This study investigated whether the SIPA can be used as an early index of prognosis for non-traumatic children visiting the pediatric emergency department (ED) and were directly admitted to the intensive care unit (ICU). We hypothesized that an increase in SIPA values in the first 24 h of ICU admission would correlate with mortality and adverse outcomes.Methods: This multicenter retrospective study enrolled non-traumatic patients aged 1–17 years who presented to the pediatric ED and were directly admitted to the ICU from January 1, 2016, to December 31, 2018, in Taiwan. The SIPA value was calculated at the time of arrival at the ED and 24 h after ICU admission. Cutoffs included SIPA values >1.2 (patient age: 1–6), >1.0 (patient age: 7–12), and >0.9 (patient age: 12–17). The utility of the SIPA and the trends in the SIPA during the first 24 h of ICU admission were analyzed to predict outcomes.Results: In total, 1,732 patients were included. Of these, 1,050 (60.6%) were under 6 years old, and the median Pediatric Risk of Mortality score was 7 (5–10). In total, 4.7% of the patients died, 12.9% received mechanical ventilator (MV) support, and 11.1% received inotropic support. The SIPA value at 24 h after admission was associated with increased mortality [odds ratio (OR): 4.366, 95% confidence interval (CI): 2.392–7.969, p < 0.001], MV support (OR: 1.826, 95% CI: 1.322–2.521, p < 0.001), inotropic support (OR: 2.306, 95% CI: 1.599–3.326, p < 0.001), and a long hospital length of stay (HLOS) (2.903 days, 95% CI: 1.734–4.271, p < 0.001). Persistent abnormal SIPA value was associated with increased mortality (OR: 2.799, 95% CI: 1.566–5.001, p = 0.001), MV support (OR: 1.457, 95% CI: 1.015–2.092, p = 0.041), inotropic support (OR: 1.875, 95% CI: 1.287–2.833, p = 0.001), and a long HLOS (3.2 days, 95% CI: 1.9–4.6, p < 0.001). Patients with abnormal to normal SIPA values were associated with decreased mortality (OR: 0.258, 95% CI: 0.106–0.627, p = 0.003), while patients with normal to abnormal SIPA values were associated with increased mortality (OR: 3.055, 95% CI: 1.472–5.930, p = 0.002).Conclusions: In non-traumatic children admitted to the ICU from the ED, increased SIPA values at 24 h after ICU admission predicted high mortality and bad outcomes. Monitoring the trends in the SIPA could help with prognostication and optimize early management.

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Section: Introductionmentioning

confidence: 99%

“…The SIPA value was calculated at the time of arrival at the ED and 24 h after ICU admission. Cutoffs included SIPA values >1.2 (patient age: 1-6), >1.0 (patient age: 7-12), and >0.9 (patient age: [12][13][14][15][16][17]. The utility of the SIPA and the trends in the SIPA during the first 24 h of ICU admission were analyzed to predict outcomes.…”

mentioning

confidence: 99%

Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Huang

Yang

et al. 2021

Front. Pediatr.

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“…In-hospital 30-day mortality was selected as the outcome. The association between SI ≥ 0.9 and mortality was analyzed [ 13 ]. In addition, to determine the advantage of SI, patients were further grouped according to SBP <90 mmHg and ≥90 mmHg.…”

Section: Methodsmentioning

confidence: 99%

“…It has been used to predict outcomes in patients with severe sepsis [ 8 , 9 ], hemorrhagic shock [ 10 ], pulmonary embolism [ 11 ], and acute myocardial infarction [ 12 ]. Maheshwari et al used a single SI reading of ≥0.9 as a predictor of mortality among critically ill patients [ 13 ]. However, few studies have used SI for predicting cardiac arrest in the ED.…”

Section: Introductionmentioning

confidence: 99%

Association between Shock Index and Emergency Department Cardiac Arrest

Chen

Wang

Wei

et al. 2021

Emergency Medicine International

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Background. In the emergency department (ED), early identification of patients at risk of cardiac arrest is paramount, especially in the context of overcrowding. The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure. It is a tool used for predicting the prognosis of critically ill and injured patients. In this study, we have discussed the relationship between SI and cardiac arrest in the ED. Methods. Patients who experienced cardiac arrest in the ED were classified into two groups, SI ≥ 0.9 and < 0.9, according to their triage vital signs. The association between SI ≥ 0.9 and in-hospital mortality was analyzed in five different etiologies of cardiac arrest, including hypoxia, cardiac cause, bleeding, sepsis, and other metabolic problems. Results. In total, 3,313 patients experienced cardiac arrest in the ED. Among them, 1,909 (57.6%) had a SI of ≥0.9. The incidence of SI ≥ 0.9 in the five etiologies was 43.5% (hypoxia), 58.1% (cardiac cause), 56.1% (bleeding), 58.0% (sepsis), and 65.5% (other metabolic problems). SI was associated with in-hospital mortality (adjusted odds ratio (aOR), 1.6; 95% confidence interval (CI), 1.5–1.8). The aOR (CI) in the five etiologies was 1.3 (1.1–1.6) for hypoxia, 1.8 (1.6–2.1) for cardiac cause, 1.3 (0.98–1.7) for bleeding, 1.3 (1.03–1.6) for sepsis, and 1.9 (1.5–2.1) for other metabolic problems. Conclusion. More than half of the patients who experienced cardiac arrest in the ED had a SI ≥ 0.9. The SI was also associated with in-hospital mortality after cardiac arrest in the ED. SI maybe used as a screening tool to identify patients at risk of cardiac arrest in the ED and a predictor of mortality in those experiencing cardiac arrest in the ED.

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“…Frequencies of clinical symptoms were selected as per common observation modified from Lawani et al SI calculated as an average heart rate/systolic blood pressure, had previously been shown to identify high risk patients in different ailments. [5][6][7] Additional information abstracted included, age of the patient and mean gestational period, details of obstetrics, gynaecological, medical and surgical history. Also bedside urinary β-HCG test was conducted to evaluate the patients for pregnancy.…”

Section: Study Design and Parametersmentioning

confidence: 99%

Performance of hemodynamic stability parameters as predictors of ectopic pregnancy, with emphasis on shock index

Khan

Chakraborty

Basu

2022

Int J Reprod Contracept Obstet Gynecol

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Background: A study was conducted to determine the utility of shock index in the diagnosis of acute rupture ectopic pregnancy (EP).Methods: A retrospective review of all ruptured ectopic pregnancy at KPC medical college and hospital a tertiary private health care centre was performed for two years (May 2018 to April 2020). During this study, we used data of 35 cases of EP among 1150 pregnant ladies admitted from time to time under emergency.Results: The mean age of the study population was 29.49±0.74 (mean±SEM) years (range 22-38 years) and mean gestational period of pregnancy was 42.2±2.0 days (range 28-90 days). The commonest presentation of clinical symptoms associated with EC was abdominal pain (91%), vaginal bleeding (89%), amenorrhea (86%), dizziness/fainting attack (17%) and shock (68%). In majority (92.3%) of the patients the shock index was >0.70 with an average of 0.9±0.03. In 60.7% of the cases the amount of haemoperitoneum found at laparatomy was >1000 ml. It was observed that most patients with EP had hemoperitoneum above 1000 ml (1140±113.6).Conclusions: Pulse rate or systolic blood pressure alone are not a good predictor to access the amount of blood loss in EP. But when they were used to calculate the SI (shock index), it was more accurate and simpler predictor for diagnosis of EP. SI may be used in guiding clinicians in providing appropriate management for EP patients especially in low-resource settings or hospitals with limited facilities.

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Abnormal shock index exposure and clinical outcomes among critically ill patients: A retrospective cohort analysis

Cited by 17 publications

References 31 publications

Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Association between Shock Index and Emergency Department Cardiac Arrest

Performance of hemodynamic stability parameters as predictors of ectopic pregnancy, with emphasis on shock index

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