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Vital signs, systemic inflammatory response syndrome (SIRS) criteria, and localized source of infection in patients with a sustained shock index (SI) elevation and patients without a sustained SI elevation. Results are either reported as the mean ± SD, or the absolute number (%) of patients with a specific source of infection.
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Introduction: Severe sepsis is a leading cause of non-coronary death in hospitals across the United States. Early identification and risk stratification in the emergency department (ED) is difficult because there is limited ability to predict escalation of care. In this study we evaluated if a sustained shock index (SI) elevation in the ED was a pr...
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Purpose of Review
The aim of this review is to analyze the cardiovascular pathophysiology of septic shock. Using visual representations of a left ventricular cycle in the pressure/volume plane, we describe hemodynamic derangement occurring in septic shock and subsequent changes at each step of treatment allowing a rapid understanding of complex alt...
Citations
... A prospective observational cohort of 25 patients with septic shock indicated that patients with an SI � 1 and central venous pressure � 8 mm Hg were unlikely to respond to volume expansion [26]. In another investigation of 295 patients with severe sepsis, a higher number of patients with sustained SI values > 0.8 required vasopressor treatments compared to those without a sustained increase in SI [27]. However, in the current study, in-hospital mortality rates in patients with an SI > 1.0 at both time zero and ICU admission were 40.9% and 45.7%, respectively (S6 Table). ...
Background
The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function.
Methods
This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (<50%).
Results
Among the 1,194 patients with septic shock, 392 (32.8%) who underwent echocardiography within 24 h of time zero were included in the final analysis (normal LVEF: n = 246; decreased LVEF: n = 146). In patients with normal LVEF, only survivors demonstrated significant improvement in SI, DSI, MSI, and Age-SI values from time zero to ICU admission; however, no notable improvements were found in all patients with decreased LVEF. The completion of vasopressor or fluid bundle components was significantly associated with improved indices in patients with normal LVEF, but not in those with decreased LVEF. In multivariable analysis, each of the four indices at ICU admission was significantly associated with in-hospital mortality (P < 0.05) among patients with normal LVEF; however, discrimination power was better in the indices for patients with lower lactate levels (≤ 4.0 mmol/L), compared to those with higher lactate levels.
Conclusions
The SI, DSI, MSI, and Age-SI at ICU admission were significantly associated with in-hospital mortality in patients with septic shock and normal LVEF, which was not found in those with decreased LVEF. Our study emphasizes the importance of interpreting shock indices in the context of LV function in septic shock.
... It has since been shown to be a simple, non-invasive risk stratification tool useful for detecting changes in cardiovascular performance before the onset of systemic hypotension and cardiorespiratory collapse, especially in patients with cardiogenic shock, sepsis, ectopic pregnancy, gastrointestinal haemorrhage and acute pulmonary embolism. [8] In the present study, in consensus with previous research on 2 500 patients by Berger et al., [9] an SA ≥0.9 at presentation had a clinically significant association with in-hospital mortality. Berger et al. [9] found that an SI >1 was the most specific predictor of both hyperlactataemia and 28-day mortality in their study, while a score of ≥0.85 predicted ICU admission in a retrospective analysis at a single centre by Keller et al. [10] Analogous application of the SI in patients with acute coronary syndrome and communityacquired pneumonia proved beneficial in other studies. ...
Background. Shock is a state of circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand, resulting in end-organ dysfunction and hypodynamic circulatory failure. Most patients with infectious and trauma-related illnesses present to the emergency department (ED) in shock.
Objectives. To study the usefulness of the shock index (SI) and modified shock index (MSI) in identifying and triaging patients in shock presenting to the ED.
Methods. This was a year-long observational, cross-sectional study of 290 patients presenting to the ED of a tertiary hospital in compensated or overt shock. The SI and MSI were calculated at the time of first contact, and then hourly for the initial 3 hours. Relevant background investigations targeting the cause of shock and prognostic markers were done. The outcome measures of mortality and intensive care unit admission were documented for each participant.
Results. The mean age of the participants was 49 years, and 67% of them were men. In consensus with local and national data, the major medical comorbidities were hypertension (20%) and diabetes mellitus (16%). An SI ≥0.9 and an MSI ≥1.3 predicted in-hospital mortality (p
... 8 The shock index that remained high during the observation was said to be able to predict an increase in organ failure in patients with severe sepsis as well as an increase in the use of vasopressors. 9 This study is aimed to find out the correlation between DSI and lactate clearance in shock patients treated at the Pediatric Intensive Care Unit (PICU) of Prof Dr. I.G.N.G Ngoerah Hospital so that later on, DSI can be used as one of the predictors of mortality in shock patients treated at PICU. We also want to know about changes in the shock index before and after resuscitation. ...
Introduction: Lactate was an examination done in patients with shock as a predictor of mortality. The delta shock index (DSI) is one of the parameters that are easy to do but very limited studies related to the benefits of DSI have been found. This study aimed at determining the correlation of DSI and lactate clearance levels in pediatric shock patients treated at the Pediatric Intensive Care Unit (PICU) of Prof Dr. I.G.N.G Ngoerah Hospital. Method: This was a prospective cohort study of children diagnosed with shock in a pediatric emergency ward or PICU Prof Dr. I.G.N.G Ngoerah Hospital. A Spearman correlation test was done since the data distribution was abnormal. Multivariate analysis with multiple regression tests was carried out to assess the pure effect of lactate clearance with DSI. The level of significance was determined based on p <0.05. The general linear model analysis is done on variables that are repeated measurements. Result: There were 39 subjects obtained in this study, with 34 subjects surviving and 5 subjects not surviving. The median lactate clearance was 28.5 (-95 - 77.7), with a median DSI of 0.45 (0.04-1.3). There were significant differences in the decrease of shock index over time (p = 0.034). The correlation test results showed a weak positive between lactate clearance with DSI (r = +0.351) and p = 0.028. Multivariate analysis test results obtained a value of â 0.002 with p = 0.071. Conclusion: There was a weak positive correlation between lactate clearance and DSI. There were significant differences in the decrease of shock index over time between survivors and non-survivors.
... 10,11 Su utilidad para detectar falla circulatoria puede mejorar cuando se evalúan de forma combinada mediante el índice de choque (ICh), 12 el cual tiene un valor normal entre 0.5 y 1, correlación positiva con el valor sérico de lactato 13 y negativa con la SvcO 2 y el gasto cardiaco, 14 además de ser un factor de riesgo para mayor uso de vasopresores y número de disfunciones orgánicas. 15 Este índice puede también ser útil para evaluar la respuesta a la reanimación hídrica 16 y predecir el desarrollo de disfunción orgánica y muerte. 17 Además, puede alertar a los clínicos acerca de un problema subyacente, como sangrado oculto 18 o sepsis. ...
... Mutschler et al. 14 identificaron que la mortalidad se incrementó cuando el ICh permaneció elevado durante varias horas en pacientes politraumatizados. Por su parte, Wira et al. 15 demostraron que los pacientes con sepsis y elevación sostenida del ICh tuvieron más disfunciones orgánicas y requirieron mayor uso de vasopresores. En nuestro estudio, la persistencia en la elevación del ICh se asoció con mayor calificación en la escala SOFA, mientras que en aquellos pacientes en quienes se logró la normalización del ICh, la calificación en la escala SOFA disminuyó progresivamente. ...
Background:
Shock is defined as an acute circulatory insufficiency that causes cellular dysfunction. The shock index (SI) and the anaerobic index or the relationship between the veno-arterial gradient of carbon dioxide and the difference between the arterial and venous content of O₂ [∆P(v-a)CO2/ΔC(a-v)O2] are markers of systemic hypoperfusion.
Objective:
To determine if there is a correlation between the SI and the anaerobic index in patients with circulatory shock.
Material and methods:
Observational and prospective study in patients with circulatory shock. The SI and the anaerobic index were calculated at admission to the intensive care unit (ICU) and during their stay. Pearson's correlation coefficient was calculated and the association of SI with mortality was explored with bivariate logistic regression.
Results:
59 patients aged 55.5 (± 16.5) years, 54.3% men, were analyzed. The most frequent type of shock was hypovolemic (40.7%). They had SOFA score: 8.4 (± 3.2) and APACHE II: 18.5 (± 6). The SI was: 0.93 (± 0.32) and the anaerobic index: 2.3 (± 1.3). Global correlation was r = 0.15; at admission r = 0.29; after 6 hours: r = 0.19; after 24 hours: r = 0.18; after 48 hours: r = 0.44, and after 72 hours: r = 0.66. The SI > 1 at ICU admission had an OR 3.8 (95% CI: 1.31-11.02), p = 0.01.
Conclusions:
The SI and the anaerobic index have a weak positive correlation during the first 48 hours of circulatory shock. The SI > 1 is a possible risk factor for death in patients with circulatory shock.
... Next, Wira et al. (20) reported that a SI elevation greater than 0.8 might be a convenient modality to identify patients with severe sepsis. Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection (21). ...
Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Materials and Methods: This research is a cohort retrospective study that analyzed 171 patients aged ≥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p <0.05). The increased risk of PIH associated with high SI score was an aRR of 1.9; 95% CI 1.03–3.57, a p-value of 0.040 among those with sepsis, and an aRR of 7.9, 95% CI 2.36–26.38, a p-value of 0.001 among those without sepsis. Conclusion: This study showed that a high SI score was associated with PIH after being controlled with other PIH risk variables. The risk of PIH associated with SI score modestly increased (2-fold increase) in those with sepsis and significantly increased (8-fold increase) in those without sepsis.
... Several large retrospective studies have shown that any shock index (SI) calculation (MSI, age SI, Pediatric adjusted Shock Index) is superior to the SBP in identifying critically ill patients. [22] Trending SI over time may identify patients at risk of septic shock and can predict vasopressor use or mortality. [23] In the pediatric population, the Pediatric adjusted shock index (SIPA) has also been used as a noninvasive marker of mortality risk in pediatric sepsis. ...
... In a study from California, the factors associated with bounce-back patients were chronic kidney disease, end-stage renal disease, congestive heart failure, and Medicaid insurance [2]. However, another study indicated that there is no relationship between bounce back and emergency crowding [3]. 1 2 3 4 2 2 5 1 6 1 A retrospective study in California found that bounce-back patients were commonly from the African American community. While it can be considered a risk factor, the same ethnicity was associated with higher discharge rates which may indicate the association between higher rates of discharge and bounce back regardless of the demographic characteristics of the patients [4]. ...
Background
"Bounce back" patients is a term used to refer to patients returning to the emergency department within 72 hours after the first visit. This can be attributed to various factors related to diagnosis, management, or the health care system.
Objective
This study sought to evaluate the extent of bounce-back patients in the emergency department of King Abdullah Medical City (KAMC), Makkah, Saudi Arabia, and then explore the possible relationship between shock index (SI) and bounce-back patients.
Methods
This is a retrospective chart review of the electronic system among patients who have returned to the emergency department within 72 hours from the index visit. All records were reviewed from May 2019 to May 2021. Vital signs were collected to calculate the shock index (heart rate/systolic blood pressure). The data were analyzed by SPSS Statistics v.27.0 (IBM Corp., Armonk, NY).
Results
A total of (506) responses were analyzed. The median age was 56 years with an IQR of 40-67, and males represented 55.3%. Around three-quarters of the second complaints (76.9%) were related to the index visit. The durations between the visits were as follows: 51.8% within 24 hours, 30.2% within 25-48 hours, and 18% within 49-72 hours. The median and IQR for shock index were 0.67 and 0.59-0.80 respectively, while the median and IQR for reverse shock index were 1.49 and 1.25-1.71 respectively. Diabetes and the duration between the two visits were associated with the complaints (p-value=0.005, p-value=0.011) respectively.
Conclusion
The majority of bounce-back cases occurred within the first 24 hours in our sample. Hypertension, diabetes, and ischemic heart diseases were the most prevalent comorbidities among the bounce-back patients. The majority of bounce-back patients (76.9%) presented with complaints related to the index visit.
... For example, a recent prospective study showed that SI can predict the risk of death in patients with sepsis (21). Charles et al. revealed that elevated SI in patients with severe sepsis in the emergency room may be an important indicator of disease escalation and risk of cardiovascular failure (22). However, scholars have mostly studied the prognostic value of static SI indicators, and we hope that by exploring the clinical significance hidden behind the change trend of SI over time, clinicians can further understand the severity of the disease of patients, which can help them make timely and effective clinical decisions and improve the prognosis of patients. ...
... The SI of the patients in classes 1 and 2 was continuously at a low level of 0.62 and 0.84, respectively. Previous studies have shown that the normal range of SI is 0.5-0.7 (22),and some scholars reported that the prognosis of severely ill patients is worse when SI > 0.9 (24). Therefore, the SI of these two classes of patients was close to the normal level, and thus it had no notable effect on the prognosis. ...
Background
Sepsis is a serious disease with high clinical morbidity and mortality. Despite the tremendous advances in medicine and nursing, treatment of sepsis remains a huge challenge. Our purpose was to explore the effects of shock index (SI) trajectory changes on the prognosis of patients within 24 h after the diagnosis of sepsis.Methods
This study was based on Medical Information Mart for Intensive Care IV (MIMIC- IV). The effects of SI on the prognosis of patients with sepsis were investigated using C-index and restricted cubic spline (RCS). The trajectory of SI in 24 h after sepsis diagnosis was classified by latent growth mixture modeling (LGMM). Cox proportional hazard model, double robust analysis, and subgroup analysis were conducted to investigate the influence of SI trajectory on in-hospital death and secondary outcomes.ResultsA total of 19,869 patients were eventually enrolled in this study. C-index showed that SI had a prognostic value independent of Sequential Organ Failure Assessment for patients with sepsis. Moreover, the results of RCS showed that SI was a prognostic risk factor. LGMM divided SI trajectory into seven classes, and patients with sepsis in different classes had notable differences in prognosis. Compared with the SI continuously at a low level of 0.6, the SI continued to be at a level higher than 1.0, and the patients in the class whose initial SI was at a high level of 1.2 and then declined had a worse prognosis. Furthermore, the trajectory of SI had a higher prognostic value than the initial SI.Conclusion
Both initial SI and trajectory of SI were found to be independent factors that affect the prognosis of patients with sepsis. Therefore, in clinical treatment, we should closely monitor the basic vital signs of patients and arrive at appropriate clinical decisions on basis of their change trajectory.
... In another study of 295 patients with severe sepsis, SI did not predict the need for vasopressor use or mortality (20). However, this issue was also seen in our study, the need to use vasopressor is a good variable for further studies, which unfortunately was not considered in our study. ...
The aim of this study was to compare the relationship between shock index (SI) and respiratory adjusted shock index (RASI) scores with the final outcome of sepsis patients referred to the emergency department. This was prospective research that examined individuals who had been diagnosed with sepsis, determined by the presence of at least two of the three quick sepsis-related organ failure assessment (qSOFA) criteria and the presence of an infectious disease based on a diagnosis made by a hospital physician of Imam Reza and Ghaemshahr of Mashhad in 2019. Demographic information of patients, SI score, RASI score, and information related to the patient's clinical symptoms were recorded in the checklist. The final outcome of this study was considered mortality. Data analysis was performed using descriptive and inferential tests. In the present study, a total of 178 patients, 46 patients (25.8%) were transferred to the intensive care unit, and 98 patients (55.1%) were admitted to the normal wards. Eighty-five patients (47.75%) died and the mean length of hospital stay of all patients was 11.07 ± 9.23 days. Forty-four patients (24.7%) had referred with a decreased level of consciousness and 44 patients (24.7%) presented with confusion. The rest of the patients reported normal levels of consciousness. Kaplan Mir analysis with log-rank was performed to determine the difference in survival distribution in different SI groups: Survival distribution was not statistically different for the four defined groups (based on statistical quartiles (P = 0.320). Receiver operator curves were considered as the date of death in the case of the deceased and the date of discharge from the hospital in the case of the living as censored. The AUC of the RASI scoring system for predicting mortality was 0.614 (P = 0.009) while this value was not significant for SI (P = 0.152). In logistic regression analysis, it was found that by adjusting for the variables of age, sex, sepsis etiology, blood pressure and heart rate, level of consciousness, and gender, patients with the lower respiratory rate (OR 1.6, z = −0.159 p = 0.007), younger age (OR 1.6, z = −0.029 p = 0.006) and higher RASI score are more in risk of mortality (OR 1.29, z = 1.209, p = 0.031). The results of our study showed that RASI scoring can be a good criterion for predicting the chance of mortality in patients with sepsis and could be used complementary to previous criteria such as SI. Patients with high RASI scores should be given more attention to reducing the chance of death.
... 17 SI score has been studied in cases such as pulmonary embolism, geriatric patients with influenza, sepsis, ectopic pregnancy, shock, early detection of transfusion need, mortality risk in myocardial infarction, mortality risk in patients with gastrointestinal bleeding, and the need for intensive care in patients admitted to the emergency department, and it has been found to be a successful prognostic marker. [18][19][20][21][22][23][24][25][26] In studies examining the relationship between COVID-19 and mortality risk, the ideal cutoff value for SI was reported as 0.93 by Doğanay et al., 10 concluded that the most useful threshold value for the SI in predicting the prognosis of COVID-19 patients is 0.9 in both situations. 28 In our study, the ideal cutoff value for SI was found to be 0.87, and the sensitivity of this cutoff value in terms of predicting mortality was 67%, the specificity was 85%, PPV 76%, NPV 78%, and YJI 0.523. ...
Objective
We aimed to compare the prognostic accuracy of shock indexes in terms of mortality in patients hospitalized with COVID 19 pneumonia.
Methods
Hospitalized patients whose COVID-19 RT-PCR test results were positive, had been performed thoracic computed tomography (CT) scan and had typical thoracic CT findings for COVID 19 included in the study.
Results
Eight hundred and one patients included in the study. Chronic obstructive pulmonary disease, congestive heart failure, chronic neurological diseases, chronic renal failure, and a history of malignancy were found to be chronic diseases that were significantly associated with mortality in patients with COVID-19 pneumonia. White blood cell, neutrophil, lymphocyte, c reactive protein, creatinine, sodium, aspartate aminotransferase, alanine aminotransferase, total bilirubin, high sensitive troponin, d-dimer, hemoglobin and platelet had a statistically significant relationship with in-hospital mortality in patients with COVID-19 pneumonia. The area under the curve (AUC) values of shock index (SI), age shock index (aSI), diastolic shock index (dSI), and modified shock index (mSI) calculated to predict mortality were 0.772, 0.745, 0.737, 0.755, and Youden Index J (YJI) values were 0.523, 0.396, 0.436, 0.452, respectively.
Conclusion
The results of this study show that SI, dSI, mSI and aSI are effective in predicting in-hospital mortality.
