Elevated lactate level and shock index in nontraumatic hypotensive patients presenting to the emergency department

Çevik, Arif Alper; Dolgun, Hakan; Öner, Setenay; Tokar, Baran; Acar, Nurdan; Özakın, Engin; Kaya, Filiz Baloğlu

doi:10.1097/mej.0000000000000110

Cited by 16 publications

(19 citation statements)

References 16 publications

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“…Lactate was found to be correlated with SI greater than 0.9 (P = 0.037 8). In the various citations we reviewed, we found no relationship between these two variables [17][18][19] .…”

Section: Discussionmentioning

confidence: 77%

Shock index as a mortality predictor in patients with acute polytrauma

Montoya

Charry

Calle‐Toro

et al. 2015

Journal of Acute Disease

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A B S T R A C TObjective: To evaluate whether the shock index (SI), given by the formula SI = heart rate/systolic blood pressure (HR/SBP), is useful for predicting mortality at 24 h in trauma patients admitted to the emergency department of a university hospital in Colombia. Methods: A database of trauma patients admitted between January 2013 and December 2013 was constructed; the result according to the shock index was determined, generating a dichotomous variable with two groups: Group A (SI < 0.9) and Group B (SI > 0.9). Univariate analysis was performed. Results: A total of 666 patients were analyzed, 83.3% (555) had SI < 0.9, and 16.7% (111) SI > 0.9. The mean age for Groups A and B was 32.4 and 35.4 respectively. The average injury severity score for both groups was 9.6 and 17.6 respectively. Mortality at 24 h after injury for both groups was 3.1% (P = 0.032) and 59.5% (P = 0.027) respectively. Conclusions: An initial shock index greater than 0.9 implies a worse prognosis 24 h after injury. The shock index predicts mortality in multiple trauma patients in the emergency department, and is also a quick and applicable in all hospital.

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“…Lactate was found to be correlated with SI greater than 0.9 (P = 0.037 8). In the various citations we reviewed, we found no relationship between these two variables [17][18][19] .…”

Section: Discussionmentioning

confidence: 77%

Shock index as a mortality predictor in patients with acute polytrauma

Montoya

Charry

Calle‐Toro

et al. 2015

Journal of Acute Disease

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“…SI, a ratio that relates HR to SBP as HR/SBP, has been proposed as a simple method to assess shock severity and response to therapy in critically ill people. In a healthy adult, the SI ranges from 0.5 to 0.7, and a SI greater than 0.9 is considered high . Early work demonstrated that SI was inversely related to left ventricular stroke work in acute circulatory failure .…”

Section: Introductionmentioning

confidence: 99%

“…Clinically, SI has been proposed as a measure of hemodynamic stability as well as a marker of early hypovolemia . The value of SI in the prehospital and hospital settings in predicting both need for hospital admission and patient outcome has also been well established …”

Section: Introductionmentioning

confidence: 99%

Utility of admission lactate concentration, lactate variables, and shock index in outcome assessment in dogs diagnosed with shock

Zollo

Ayoob²,

Prittie

et al. 2019

J Vet Emergen Crit Care

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Objective:To determine whether admission venous plasma lactate concentration, calculated lactate variables, or shock index (SI) could discriminate hospital survivors from nonsurvivors in dogs admitted with shock. Design:Prospective investigation performed over a 19-month period.Setting: Large urban private teaching hospital.with initial peripheral venous plasma lactate concentration >2 mmol/L (18.0 mg/dL) and clinical and hemodynamic parameters consistent with shock. Interventions: None.Measurements and Main Results: Heart rate, systolic blood pressure, and venous plasma lactate concentrations were serially recorded at predefined time points and used to calculate SI (SI = heart rate/systolic blood pressure) and lactate variables, including lactime (time lactate > 2.0 mmol/L), lactate clearance ([lactate initial -lactate delayed ]/lactate initial × 100), and LAC AREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge.Overall survival rate was 61%. Admission venous plasma lactate concentration did not differ between groups (P = 0.2). Lactime was shorter in survivors versus nonsurvivors (P = 0.02). Lactate clearance at 1, 10, 16, 24, and 36 hours, and final lactate clearance were greater in survivors versus nonsurvivors (P < 0.05). LAC AREA at time intervals 0-1, 1-4, 4-10, 10-16, 16-24, 24-30, and 30-36 hours was larger in nonsurvivors versus survivors (P < 0.05). Total LAC AREA did not differ between groups (P = 0.09). Admission SI and time to normalize SI (SI < 0.9) were not different between survivors and nonsurvivors (P > 0.05). Conclusions:While admission venous plasma lactate concentration could not discriminate between hospital survivors and nonsurvivors, lactate variables showed clinical utility to predict outcome in dogs with shock. Further studies are needed to determine SI reference ranges and optimal SI cut-off values to improve its prognostic ability in sick dogs. K E Y W O R D Scanine, hypoperfusion, perfusion parameters, resuscitation Abbreviations: ED, emergency department; HR, heart rate; SI, shock index; SBP, systolic blood pressure.

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“…In support of the rational suggestion to rely on multiple parameters for early prediction of outcome of shocked ICU patients, Cevik et al [47] found that in patients who had elevated BLL and SI, the use of mechanical ventilation and vasoactive drug was significantly higher with higher hospitalization rate and in-hospital mortality (54.1%) than in patients who had elevation of either parameter alone and concluded that combination of both parameters is effective in predicting these outcome measures with higher sensitivities and NPV. Shackelford et al [48] reported that automated analysis of triage vital signs, 15 min of pulse oximetry signals, and laboratory values including BLL predicted use of blood transfusion during trauma resuscitation more accurately than triage vital signs or pulse oximetry analysis alone.…”

Section: Discussionmentioning

confidence: 99%

Disturbed fluid responsiveness and lactate/pyruvate ratio as predictors for mortality of septic shock patients

Mohamed

Essam

2016

Egyptian Journal of Anaesthesia

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Objectives: Evaluation of fluid responsiveness of septic shock patients admitted to surgical ICU and the predictability of non-invasive monitoring and estimated lactate/pyruvate (L/P) ratio for survival of these patients. Patients and methods: The study included 58 septic shocked patients admitted and managed at surgical ICU. After non-invasive determination of baseline hemodynamic data and calculation of shock index (SI-0) and Pleth variability index (PVI-0), all patients received intravenous colloid infusion followed 15-min later by non-invasive re-evaluation for SI-15 and PVI-15. Blood samples were obtained for estimation of blood lactate and pyruvate levels at admission (BLL-0 and BPL-0) and 12-h after fluid resuscitation (BLL-12 and BPL-12) and L/P ratio was calculated. All patients were managed according to the Surviving Sepsis Campaign guidelines and followed up for ICU mortality rate (MR). Results: ICU stay MR was 20.7%. Survival showed negative significant correlation with PVI, L/P ratio and BLL, while it showed positive significant correlation with BPL. Receiver Operating Characteristic (ROC) curve analysis defined baseline and persistently low PVI, high BLL and L/P ratio as significant sensitive predictors for MR, while elevated BPL-12 as significant specific predictor for survival. Regression analysis defined persistently elevated L/P ratio as the highly significant specific predictor, while persistently disturbed SI and PVI could predict mortality as screening tests. Odds ratio for mortality at BLL-0 of >2 mmol/L was 0.0321 (95% CI: 0.0037-0.2755), while it was 4.1111 (95% CI: 1.0702-15.792) at BLL-0 >4 mmol/L. Conclusion: After fluid resuscitation and hemodynamic stability, persistently elevated BLL could predict mortality, while elevated BPL could predict survival of septic shock patients. Continuous non-invasive evaluation of fluid responsiveness judged by PVI and SI could provide sensitive

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Elevated lactate level and shock index in nontraumatic hypotensive patients presenting to the emergency department

Abstract: The combination of both parameters is effective in predicting these outcome measures with higher sensitivities and NPVs. Further studies on the subject are required.

Cited by 16 publications

References 16 publications

Shock index as a mortality predictor in patients with acute polytrauma

Shock index as a mortality predictor in patients with acute polytrauma

Utility of admission lactate concentration, lactate variables, and shock index in outcome assessment in dogs diagnosed with shock

Disturbed fluid responsiveness and lactate/pyruvate ratio as predictors for mortality of septic shock patients

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