Shock Index: A Simple and Effective Clinical Adjunct in Predicting 60-Day Mortality in Advanced Cancer Patients at the Emergency Department

Abstract

<jats:p>Deciding between palliative and overly aggressive therapies for advanced cancer patients who present to the emergency department (ED) with acute issues requires a prediction of their short-term survival. Various scoring systems have previously been studied in hospices or intensive care units, though they are unsuitable for use in the ED. We aim to examine the use of a shock index (SI) in predicting the 60-day survival of advanced cancer patients presenting to the ED. Identified high-risk patients and their families can then be counseled accordingly. Three hundred and five advanced cancer patients who presented to the EDs of three tertiary hospitals were recruited, and their data retrospectively analyzed. Relevant data regarding medical history and clinical presentation were extracted, and respective shock indices calculated. Multivariate logistic regression analyses were performed. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of the SI. Nonsurvivors within 60 days had significantly lower body temperatures and blood pressure, as well as higher pulse rates, respiratory rates, and SI. Each 0.1 SI increment had an odds ratio of 1.39 with respect to 60-day mortality. The area under the ROC curve was 0.7511. At the optimal cut-off point of 0.94, the SI had 81.38% sensitivity and 73.11% accuracy. This makes the SI an ideal evaluation tool for rapidly predicting the 60-day mortality risk of advanced cancer patients presenting to the ED. Identified patients can be counseled accordingly, and they can be assisted in making informed decisions on the appropriate treatment goals reflective of their prognoses.</jats:p>

Shock Index Is a Validated Prediction Tool for the Short-Term Survival of Advanced Cancer Patients Presenting to the Emergency Department

“…Even when detailed records of cancer patients’ clinical progression and treatment history were made available, physicians could predict 180-day mortality accurately only three out of four times [ 14 ]. With comparable accuracy rates of 73.11% in our retrospective study and 66.10% in this current validation study, SI is therefore a powerful risk stratification tool for rapid prognostication of 60-day mortality in advanced cancer patients presenting to the ED [ 18 ].…”

“…If advanced cancer patients presenting to the ED are unlikely to survive past 59 days, it then stands to reason that they should be provided early with the option of palliative care services. Based on this, we embarked on a retrospective study that found shock index (SI) to be an ideal tool in predicting the 60-day mortality risk of advanced cancer patients presenting to the ED [ 18 ]. SI is defined as the ratio of pulse rate to systolic blood pressure [ 19 ] and has been widely studied in the prognostication of pneumonia [ 20 , 21 , 22 ], influenza [ 23 ], Coronavirus disease 2019 [ 24 ], acute pulmonary embolism [ 25 ], acute myocardial infarction [ 26 , 27 ], stroke [ 28 ], and trauma [ 29 , 30 ].…”

“…This study is part of a series by the Stratification to Prevent Overcrowding Taskforce (SPOT) investigators, a research group dedicated to maximising clinical outcomes right from the ED via rapid and accurate identification of patients requiring urgent intervention, with the secondary objective of alleviating ED overcrowding. We have to date studied several risk stratification tools in intra-abdominal infections [ 31 , 32 , 33 , 34 , 35 , 36 ], snakebites [ 37 ], and now advanced cancer [ 18 ], amongst others [ 38 , 39 ].…”

Predicting in-hospital mortality in ICU patients with sepsis using gradient boosting decision tree

“…[ 24 ] Some studies have shown that LR is effective in analyzing mortality factors and predicting mortality. [ 25 , 26 ]…”

Palliative and End-of-Life Care: More Work is Required

“…Two studies identified factors of survivorship of palliative care patients using data from routine records. Cheng and colleagues [ 5 ] used data from the medical records of 305 patients with advanced cancer attending the Emergency Departments of three hospitals in Taiwan, showing the strong predictive power of a simple index, named the Shock index (pulse rate/systolic blood pressure), in predicting 60-day survival rate. Kawakami and Hamano [ 6 ] analyzed data from 106 residents with moderate-to-severe impairment of activities of daily living (ADL) and cognitive frailty in a nursing home in Japan, showing that change in body mass index, energy intake, and fluid intake were prognostic factors for death.…”