Utility of the Shock Index for Risk Stratification in Patients with Acute Upper Gastrointestinal Bleeding

Rassameehiran, Supannee; Teerakanok, Jirapat; Suchartlikitwong, Sakolwan; Nugent, Kenneth

doi:10.14423/smj.0000000000000729

Cited by 29 publications

(23 citation statements)

References 26 publications

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“…In a study among healthy participants with blood loss of 450 ml, the SI was substantially increased whereas the HR and SBP remained within the normal ranges [ 44 ]. Classification of patients by an SI > 0.7 can preferentially select patients with adverse short-term outcomes from among those with upper gastrointestinal bleeding [ 45 ]. With SI above 0.9, the risk for trauma patients requiring massive transfusion rises substantially [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Identification of Pancreatic Injury in Patients with Elevated Amylase or Lipase Level Using a Decision Tree Classifier: A Cross-Sectional Retrospective Analysis in a Level I Trauma Center

Rau

Chien

et al. 2018

IJERPH

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Background: In trauma patients, pancreatic injury is rare; however, if undiagnosed, it is associated with high morbidity and mortality rates. Few predictive models are available for the identification of pancreatic injury in trauma patients with elevated serum pancreatic enzymes. In this study, we aimed to construct a model for predicting pancreatic injury using a decision tree (DT) algorithm, along with data obtained from a population-based trauma registry in a Level I trauma center. Methods: A total of 991 patients with elevated serum levels of amylase (>137 U/L) or lipase (>51 U/L), including 46 patients with pancreatic injury and 865 without pancreatic injury between January 2009 and December 2016, were allocated in a ratio of 7:3 to training (n = 642) or test (n = 269) sets. Using the data on patient and injury characteristics as well as laboratory data, the DT algorithm with Classification and Regression Tree (CART) analysis was performed based on the Gini impurity index, using the rpart function in the rpart package in R. Results: Among the trauma patients with elevated amylase or lipase levels, three groups of patients were identified as having a high risk of pancreatic injury, using the DT model. These included (1) 69% of the patients with lipase level ≥306 U/L; (2) 79% of the patients with lipase level between 154 U/L and 305 U/L and shock index (SI) ≥ 0.72; and (3) 80% of the patients with lipase level <154 U/L with abdomen injury, glucose level <158 mg/dL, amylase level <90 U/L, and neutrophil percentage ≥76%; they had all sustained pancreatic injury. With all variables in the model, the DT achieved an accuracy of 97.9% (sensitivity of 91.4% and specificity of 98.3%) for the training set. In the test set, the DT achieved an accuracy of 93.3%, sensitivity of 72.7%, and specificity of 94.2%. Conclusions: We established a DT model using lipase, SI, and additional conditions (injury to the abdomen, glucose level <158 mg/dL, amylase level <90 U/L, and neutrophils ≥76%) as important nodes to predict three groups of patients with a high risk of pancreatic injury. The proposed decision-making algorithm may help in identifying pancreatic injury among trauma patients with elevated serum amylase or lipase levels.

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Section: Discussionmentioning

confidence: 99%

Identification of Pancreatic Injury in Patients with Elevated Amylase or Lipase Level Using a Decision Tree Classifier: A Cross-Sectional Retrospective Analysis in a Level I Trauma Center

Rau

Chien

et al. 2018

IJERPH

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“…The SI can provide a comprehensive assessment of cardiovascular status and can be used to estimate the amount of blood loss and degree of shock (normal range: 0.5 to 0.7) [7]. A study by Rassameehiran et al showed that the SI was a good tool to identify patients with the potential for short-term adverse outcomes when they presented with upper gastrointestinal bleeding, and the SI was performed, as well as other risk-scoring tools, for gastrointestinal bleeding [22]. In this study, it was determined that the GBSs of patients with PUB were positively correlated with the SI, i.e., the higher the SI, the higher the GBS.…”

Section: Discussionmentioning

confidence: 99%

Correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding

Hong¹,

Pan²,

Liu³

et al. 2020

Turk J Med Sci

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Background/aim: To investigate the correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding (PUB). Materials and methods:A total of 955 patients with PUB were assessed using the Glasgow-Blatchford score and shock index, as well as the Forrest classification based on their gastroscopy results. The correlation between the Glasgow-Blatchford score and shock index was determined using scatter plot analysis, and the correlation between the Glasgow-Blatchford score or shock index and Forrest classification was determined using Spearman's analysis.Results: Both the Glasgow-Blatchford score and shock index showed the highest values in patients with Forrest class IIa. The Glasgow-Blatchford score was significantly higher than patients with Forrest class Ib/IIc/III (P < 0.05), and the shock index was significantly higher than patients with Forrest class Ib/IIb/III (P < 0.05). A positive correlation was observed between the Glasgow-Blatchford score and shock index, at r = 0.427 (P < 0.001). A negative correlation was observed between the Glasgow-Blatchford score and Forrest classification, at r = -0.111 (P < 0.01), and between the shock index and Forrest classification, at r = -0.138 (P < 0.01). Conclusion:A moderate correlation was observed between the Glasgow-Blatchford score and shock index in patients with PUB, and the correlation between the Forrest classification and Glasgow-Blatchford score or shock index was relatively low.

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“…To date, there are limited data on the use of the Shock Index in upper GI bleeding. Two small retrospective studies suggested that the Shock Index correlates with angiographic visualisation of bleeding, and that a Shock Index of >0.7 predicts need for endoscopic therapy and worse outcomes . Another retrospective study suggested that a Shock index >1.0 identifies patients at higher risk of hyperlactaemia and 28‐day mortality .…”

Section: Introductionmentioning

confidence: 99%

“…Two small retrospective studies suggested that the Shock Index correlates with angiographic visualisation of bleeding, and that a Shock Index of >0.7 predicts need for endoscopic therapy and worse outcomes. 7,8 Another retrospective study suggested that a Shock index >1.0 identifies patients at higher risk of hyperlactaemia and 28-day mortality. 5 A prospective study described a simplified scoring system incorporating the Shock Index and found this to be comparable to the GBS in predicting high-risk endoscopic stigmata, re-bleeding and 30-day bleeding-related mortality.…”

Section: Introductionmentioning

confidence: 99%

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

Saffouri

Blackwell

Laursen

et al. 2019

Aliment Pharmacol Ther

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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.]

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Utility of the Shock Index for Risk Stratification in Patients with Acute Upper Gastrointestinal Bleeding

Cited by 29 publications

References 26 publications

Identification of Pancreatic Injury in Patients with Elevated Amylase or Lipase Level Using a Decision Tree Classifier: A Cross-Sectional Retrospective Analysis in a Level I Trauma Center

Identification of Pancreatic Injury in Patients with Elevated Amylase or Lipase Level Using a Decision Tree Classifier: A Cross-Sectional Retrospective Analysis in a Level I Trauma Center

Correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding

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

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