Shock Index and Prediction of Traumatic Hemorrhagic Shock 28-Day Mortality: Data from the DCLHb Resuscitation Clinical Trials

Abstract

IntroductionTo assess the ability of the shock index (SI) to predict 28-day mortality in traumatic hemorrhagic shock patients treated in the diaspirin cross-linked hemoglobin (DCLHb) resuscitation clinical trials.MethodsWe used data from two parallel DCLHb traumatic hemorrhagic shock efficacy trials, one in U.S. emergency departments, and one in the European Union prehospital setting to assess the relationship between SI values and 28-day mortality.ResultsIn the 219 patients, the mean age was 37 years, 64% sustained a blunt injury, 48% received DCLHb, 36% died, and 88% had an SI≥1.0 at study entry. The percentage of patients with an SI≥1.0 dropped by 57% (88 to 38%) from the time of study entry to 120 minutes after study resuscitation (p<0.001). Patients with a SI≥1.0, 1.4, and 1.8 at any time point were 2.3, 2.7, and 3.1 times, respectively, more likely to die by 28 days than were patients with SI values below these cutoffs (p<0.001). Similarly, after 120 minutes of resuscitation, patients with a SI≥1.0 were 3.9× times more likely to die by 28 days (40 vs. 15%, p<0.001). Although the distribution of SI values differed based on treatment group, the receiver operator characeristics data showed no difference in SI predictive ability for 28-day mortality in patients treated with DCLHb.ConclusionIn these traumatic hemorrhagic shock patients, the shock index correlates with 28-day mortality, with higher SI values indicating greater mortality risk. Although DCLHb treatment did alter the distribution of SI values, it did not influence the ability of the SI to predict 28-day mortality.

Clinical metrics in emergency medicine: the shock index and the probability of hospital admission and inpatient mortality

“…Sloan et al reported that trauma patients with an SI ≥1.0, 1.4 and 1.8 at any time point were 2.3, 2.7 and 3.1 times, respectively, more likely to die within 28 days than were patients with SI values below these cut-offs (p<0.001). In the same study, and after 120 min of resuscitation, patients with an SI ≥1.0 were 3.9 times more likely to die within 28 days (40% vs 15%, p<0.001) 24. A recent retrospective study of 20 000 adult patients from the trauma registry demonstrated that an SI of ≥1.4 was associated with worst injury severity score, largest fluid requirements, greatest transfusion requirements and highest proportion of patients transfused.…”

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

“…Its predicting value for the outcome has been fully demonstrated in the patients with trauma [1][2][3][4]. Recently, some studies further showed that a new index, MSI, in the ED is a more valuable marker for predicting the mortality rate than SI alone in adult patients with trauma [14].…”

“…It has been demonstrated as a useful predictor for hospital mortality among adult patients with trauma [1][2][3]. Shock index is better not only than SBP, diastolic blood pressure (DBP), and HR alone but also than some risk stratification systems, for example, SI is more useful than the Triage Sort (TSO) for secondary triage in a mass-casualty situation [4].…”

Hemoglobin-Based Blood Substitutes and the Treatment of Sickle Cell Disease: More Harm than Help?

“…Like DCLHb this Hb had a P 50 value close to that of normal red blood cells (RBCs). Some Phase I/II clinical trials in elective surgeries with Optro (5 g Hb/dL) were conducted but discontinued due to the hypertensive effects and other related adverse events [16]. …”