The shock index predicts acute mortality outcomes in stroke

McCall, Steve; Musgrave, Stanley D.; Potter, John F.; Hale, Rachel; Clark, Allan; Mamas, Mamas A.; Metcalf, Anthony K.; Day, Diana J.; Warburton, Elizabeth A.; Bachmann, Max; Myint, Phyo Kyaw

doi:10.1016/j.ijcard.2014.12.175

Cited by 23 publications

(22 citation statements)

References 22 publications

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“…Conversely, large strokes with dysphagia or posterior circulation strokes presenting with vomiting present a high risk of aspiration pneumonia and may be associated with higher SI, as they are more likely to cause higher heart rate and lower systolic BP. Consequently, a potential U‐ or J‐shaped relationship was expected between SI and selected outcomes; however, we did not find the U‐shaped relationship that was observed in the study by McCall et al 6. Of note, McCall and colleagues did not adjust for poststroke complications, which could influence the outcomes examined.…”

Section: Discussioncontrasting

confidence: 64%

“…McCall and colleagues previously examined the link between SI and acute stroke mortality in a much smaller sample (n=2121). They found similar results demonstrating that high SI value was associated with increased inpatient mortality (odds ratio: 1.85; 95% confidence interval, 1.17–2.92) 6. Of note, their population was predominantly white (>95%), and they were not able to control for some key variables of initial stroke severity, such as NIHSS or poststroke complications.…”

Section: Discussionmentioning

confidence: 79%

“…Indeed, both heart rate and systolic BP can be accurately measured and recorded in any hospital setting without special training. Furthermore, McCall et al already demonstrated that using SI has greater predictive ability than systolic BP with regard to short‐term mortality 6. In clinical practice, information on vital signs can be readily abstracted from routine examination; therefore, SI can be easily calculated, and using SI could improve prediction of outcomes for individual patients as well as risk adjustment.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, high SI has been reported to have prognostic significance in trauma3 and acute cardiovascular events such as acute myocardial infarction and stroke 4, 5, 6. Although heart rate and BP are important variables in predicting acute stroke outcome, physiologically they are linked to each other.…”

mentioning

confidence: 99%

“…McCall et al6 were the first to report the relationship between this simple and readily available physiological index and acute stroke mortality. In their UK‐based multicenter study (N=2121), the authors demonstrated that whereas the higher SI is associated with increased risk of in‐hospital mortality, both low and high SIs (low SI indicating presence of Cushing reflex) were associated with early mortality within 3 and 7 days, albeit with higher odds associated with high SI compared with low SI.…”

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confidence: 99%

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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: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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