The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding

Abstract

Summary Background Acute upper gastrointestinal bleeding (UGIB) remains a major cause of hospital admission worldwide. The recent UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on severe gastrointestinal bleeding used the Shock Index to assess bleeding severity and found an association between Shock Index and mortality. However, this has never been prospectively validated as a predictor of outcome in UGIB. Aims To compare the Shock Index with existing pre‐endoscopic UGIB risk scores in predicting outcomes after UGIB Methods In an international, prospective study of 3012 consecutive patients with UGIB, we compared the Shock Index with existing scores including the Glasgow Blatchford score (GBS), admission Rockall score, AIMS65, and the newly described “ABC” score. Pre‐determined endpoints were need for major (≥4 units red cells) transfusion, need for endoscopic therapy and 30‐day mortality. Results The Shock Index was inferior to the GBS in predicting need for major transfusion (area under the receiver operator characteristic curve [AUROC] 0.655 vs 0.836, P < 0.001) and need for endotherapy (AUROC 0.606 vs 0.747, P < 0.001). The Shock Index was inferior to all other scores for 30‐day mortality: for example, AUROC 0.611 vs 0.863 for ABC score (P < 0.001). Adding the Shock Index to the ABC score did not improve accuracy of the ABC score in predicting mortality (AUROC 0.864 vs 0.863, P = 0.95). Conclusion The Shock Index performed poorly with AUROCs <0.66 and was inferior to existing pre‐endoscopy scores at predicting major clinical endpoints after UGIB. We found no clear evidence that the Shock Index is clinically useful at predicting outcomes in UGIB. [Correction added on 20 December 2019, after first online publication: Summary section has been changed for clarification.]

The Clinical Value of Multislice Spiral Computed Tomography in the Diagnosis of Upper Digestive Tract Diseases

“…Gastrointestinal bleeding is a common clinical condition, most of which can be identified by gastroscopy and colonoscopy [1]. e American Gastroenterological Association defines obscure gastrointestinal bleeding (OGIB) as persistent or recurrent gastrointestinal bleeding, in which no lesion can be detected by conventional gastroscopy or fiberoptic colonoscopy [2].…”

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study

“…9 In a study by Saffouri et al, the shock index was found to have weaker performance than other scoring systems for predicting 30-day mortality among patients with acute upper GI bleeding. 26 In our study, we found that the shock index and AIMS-65 score had statistically better results than the Rockall and Glasgow- found that the performance of the shock index was weak with regard to predicting the 30-day mortality rate in their study. 26 We think that the fact that the patients included in their study were younger and had less comorbidity may have caused that result.…”

Prediction of hospitalization and blood transfusion requirement in patients with macroscopic hematuria

“…While predicting need for hospitalization, cut-off values for SI and PR were calculated as >0.68 and >80 beats/min, respectively. Saffouri et al (21) found that SI is useful when predicting need for major transfusion, which means more than 4 units of erythrocyte suspension, in patients with upper gastrointestinal hemorrhage. El-Menyar et al (22) reported that SI can be used to predict massive BT or laparotomy requirement and mortality in trauma patients.…”