Shock index: a re-evaluation in acute circulatory failure

Rady, Mohamed Y.; Nightingale, Peter; Little, R. A.; Edwards, Joseph

doi:10.1016/0300-9572(92)90006-x

Cited by 209 publications

(165 citation statements)

References 12 publications

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“…Previous studies have used SI to assess outcomes in patients with community‐acquired pneumonia and acute circulatory failure and to predict those who would require immediate intensive therapy 1, 16, 17, 18. Moreover, a recent study that used prospectively collected audit data showed that an SI >1.0 was predictive of inpatient mortality in individuals aged >90 years 19.…”

Section: Discussionmentioning

confidence: 99%

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Myint

Sheng

Xian

et al. 2018

JAHA

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BackgroundThe prognostic value of shock index (SI), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood.Methods and ResultsWe examined the Get With The Guidelines–Stroke (GWTG‐Stroke) data to explore the usefulness of SI in predicting in‐hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [CI], 1.92–2.08) for in‐hospital mortality, 1.46 (95% CI, 1.43–1.49) for longer length of hospital stay >4 days, 1.50 (95% CI, 1.47–1.54) for discharge destination other than home, 1.41 (95% CI, 1.38–1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI, 1.47–1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG‐Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS.Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.

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Section: Discussionmentioning

confidence: 99%

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Myint

Sheng

Xian

et al. 2018

JAHA

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“…14 El índice de shock ya se ha relacionado con la detección temprana 15 En ambos grupos se evidencio un índice de shock anormal (> 0.7) y con evidencia de inestabilidad hemodinámica (> 1.0). 16 Sin embargo no existe ninguna publicación en la cual se haya intentado usar este índice para predecir CCD, el resultado del estudio a pesar de la asociación de estudios previos del IS a los pacientes más críticos y severos victimas del trauma, no es suficientemente fuerte para encontrar un punto de corte, por lo cual no es candidato para ser incluido en protocolos de Trauma, a pesar de evidenciarse un IS mayor en los pacientes con CCD. La hemorragia por trauma es una de las principales causas de muerte, en un 30% a 40% de todas las muertes ocasionadas por trauma.…”

Section: Discussionunclassified

Indice de Shock: ¿Puede Predecir La Necesidad de Cirugia de Conrol de Daños En Trauma Penetrante?

Ordóñez¹,

Orozco²,

Puyana³

et al. 2017

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introducción:Valores elevados del Índice de Shock (IS) se han asociado con un incremento en la mortalidad y con la necesidad de requerimiento de transfusiones masivas en pacientes traumatizados, pero su habilidad para identificar pacientes que requieran Cirugía de Control de Daños (CCD) es desconocida. El objetivo de este estudio fue identifica un punto de corte del IS para predecir necesidad de CCD en pacientes con trauma penetrante. Materials y métodos:Estudio retrospectivo por un periodo de 10 años que incluyo todos los pacientes adultos que ingresaron por trauma penetrante de torso a un Centro de Trauma de referencia. El IS fue calculado al ingreso y los pacientes se dividieron en los que necesitaron CCD y los que no (No-CCD). Para determinar la exactitud del IS identificando pacientes que requirieron CCD se calculo el Área Bajo la Curva ROC (AUROC) del 95%. Conclusión: El IS puede ser en cierto grado indicativo de la necesidad de CCD en los pacientes con trauma penetrante de torso, sin embargo un punto específico de corte para predecir CCD no fue estadísticamente encontrado. Source of support: Nil Conflict of interest: None ABSTRACT Introduction:The objective of our study was to identify a possible shock index (SI) cutoff number that could reliable predicts the need for damage control surgery (DCS) in penetrating trauma patients. Materials and methods:A retrospective 10-year study (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) which included all adult patients that suffered penetrating torso trauma at a level I trauma center. The SI was calculated upon admission and patients were divided into two groups: those that required DCS and those that did not (No-DCS). A 95% confidence interval for the area under a receiver operating characteristic curve (AUROC) was used to determine the accuracy of SI in detecting patients that would require DCS.Results: A total of 747 patients were included, 92.3% were male and 80% suffered gunshot wounds. The DCS group had a total of 331 (44%) Conclusions:We have shown that SI can be indicative to some degree of the need for DCS in patients suffering penetrating torso trauma but a specific cutoff point that can precisely predict this need is statically unobtainable.

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“…In fact, as an integrated index of the 2 variables, SI is a sensitive indicator of left ventricular dysfunction and has been shown to be a better measure of the degree of hemodynamic stability than HR or SBP alone [16]. Furthermore, even in the presence of normal HR and BP, SI has been demonstrated to be a useful marker of early acute hypovolemia [17], and a persistent elevation of the SI for several hours would significantly increase the morbidity and mortality in acute circulatory failure [10]. Moreover, SI is mostly independent of pain and anxiety [18], which cause a concurrent increase in HR and SBP, and therefore, was a relatively objective indicator reflecting the disease state.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of shock index, defined as the ratio of heart rate and systolic blood pressure, first introduced by Allgower et al, in 1967 as a simple and effective means for gauging the degree of hypovolemia in hemorrhagic and infectious shock states [9]. Subsequently, experimental and clinical studies demonstrated that SI was inversely related to physiologic parameters, such as cardiac index, stroke volume, left ventricular stroke work, and mean arterial pressure [10].A new index, modified shock index (MSI), is created by as the ratio of HR and mean arterial pressure (MAP). He noticed that SI uses only systolic blood pressure, but diastolic blood pressure (DBP) is also of undeniable importance when determining patient's clinical severity.…”

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confidence: 99%

Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

2016

JCCR

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Submit Manuscript | http://medcraveonline.com 8]. The concept of shock index, defined as the ratio of heart rate and systolic blood pressure, first introduced by Allgower et al, in 1967 as a simple and effective means for gauging the degree of hypovolemia in hemorrhagic and infectious shock states [9]. Subsequently, experimental and clinical studies demonstrated that SI was inversely related to physiologic parameters, such as cardiac index, stroke volume, left ventricular stroke work, and mean arterial pressure [10].A new index, modified shock index (MSI), is created by as the ratio of HR and mean arterial pressure (MAP). He noticed that SI uses only systolic blood pressure, but diastolic blood pressure (DBP) is also of undeniable importance when determining patient's clinical severity. Hence he incorporated diastolic blood pressure and developed the modified shock index (MSI) [16]. Subjects and MethodsThis study was carried prospectively and included 216 patients who presented to CCU of Cardiology department, Zagazig university hospitals with acute STEMI who were treated with PPCI (from 1/2014 until 8/2016), with A time window for doing PPCI of 12 hours from onset of maximum chest pain. Extended time window to 18 hours from onset of maximum chest pain was used for patients presented with cardiogenic shock. We excluded the patients who, received fibrinolytic therapy, presented more than 12 hours from the onset of chest pain except for whom presented with cardiogenic shock, died at ER or before doing PPCI and presented by acute hemorrhage, acute hypovolemia, severe sepsis, severe trauma, or suspicion of pulmonary embolism.Patients who met the inclusion criteria were subjected to thorough history taking, Physical examination with special emphasis on both Blood pressure and pulse that were measured accurately in the supine position with >2 readings were taken with 1 min interval, and averaged. Admission SI was calculated for every patient that equals (admission HR/ admission SBP). Modified Admission SI was calculated for every patient that equals (admission HR/ mean admission BP, here MBP= [(DBPx2) +SBP]/3). The optimal cut-off values of SI, and MSI were based on optimizing the sum of sensitivity and specificity by receiver operating characteristic curve analysis, which predicted inhospital major adverse cardiovascular events.The patients were divided into 4 groups: The TIMI risk score was calculated for each patient using the variables obtained at admission according to the published criteria [5]. Killip's classification, Chest examination: with emphasis on detecting pulmonary edema or presence of pulmonary congestion, Cardiac examination: with emphasis on detecting murmurs Volume 7 Issue 4 -2016

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Shock index: a re-evaluation in acute circulatory failure

Cited by 209 publications

References 12 publications

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Indice de Shock: ¿Puede Predecir La Necesidad de Cirugia de Conrol de Daños En Trauma Penetrante?

Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

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