Value Of Shock Index Research Articles

Shock index is associated with mortality in canine vehicular trauma patients.

To calculate and compare shock index (SI) in healthy dogs and vehicular trauma dogs (VT), determine the prognostic value of SI in VT dogs, and to assess the correlation between SI and the animal trauma triage score, modified Glasgow Coma Scale score, and lactate in VT dogs. Retrospective study from April 2016 to February 2018. Twenty-four-hour tertiary referral level II trauma center. One hundred twenty-one dogs presented to the emergency service for VT and 60 healthy control dogs. None. Heart rate and systolic blood pressure were measured on each patient and used to calculate SI. SI was significantly higher in VT dogs compared to healthy control dogs (median SI, 1.0vs 0.75; P< 0.0001). SI was significantly higher in those that died versus those that survived to discharge (median, 1.27vs 0.96; P= 0.017). SI positively correlated with animal trauma triage score (95% confidence interval, 0.039-0.49; P= 0.019; r= 0.26) but did not with plasma lactate level at presentation (P= 0.068; r= 0.22) or modified Glasgow Coma Scale (P= 0.85; r=-0.021, 95% confidence interval, -0.24 to 0.20). SI is easy to calculate during triage of a trauma patient. Given its significant relationship with mortality, higher SIs should prompt the clinician to pursue additional monitoring, diagnostics, and intervention.

Importance of shock index in the evaluation of postpartum hemorrhage cases that necessitate blood transfusion

ABSTRACT This study aims to determine cutoff values for shock index (SI) to predict the need for transfusion and composite adverse outcomes in postpartum hemorrhage (PPH) cases. One hundred thirty PPH cases (study group) that necessitated blood transfusion were retrospectively compared to a frequency-matched control group (n = 130). Receiver operating characteristic (ROC) curves and decision tree [Classification & Regression Tree (C&RT) and Chi-square Automatic Interaction Detector (CHAID)] were used to identify cutoff values for SI. Cutoff values for postdelivery, peak and delta SI values for the prediction of PPH that required transfusion were 0.9125 (0.815 sensitivity, 0.923 specificity), 0.9145 (0.892 sensitivity, 0.823 specificity) and 0.195 (0.823 sensitivity, 0.885 specificity), while cutoff values for the same SI values in the prediction of composite adverse outcome were 1.315 (0.645 sensitivity, 0.616 specificity), 1.183 (0.613 sensitivity, 0.737 specificity) and 0.487 (0.710 sensitivity, 0.758 specificity). Delta SI was superior to postdelivery and peak SI in the prediction of PPH that required transfusion. Peak SI was superior to postdelivery and delta SI in the prediction of composite adverse outcome. In conclusion, increased postdelivery, peak, and delta SI values were related to adverse outcomes for PPH. SI seems to be a practical and effective method for the objective assessment of postpartum hemorrhage.

Shock Index in the Prediction of Adverse Maternal Outcome.

WHO states that obstetric hemorrhage, hypertensive disorders of pregnancy and sepsis account for approximately 50% of maternal deaths worldwide. All these conditions are associated with changes in vital signs including blood pressure (BP) and heart rate (HR). Shock index (SI) is the ratio of HR to systolic BP. To evaluate role of shock index as an early indicator of adverse maternal outcomes and to determine the threshold points of SI for five adverse maternal outcomes. This was a prospective observational study on 1004 consecutively enrolled subjects presenting in labor. Vital signs and Shock Index were recorded. SI thresholds were analyzed with respect to obstetric complications and adverse outcomes. Parametric tests such as Chi-square, comparison of proportions, comparison of mean and ROC curve analysis were applied on the data. The mean SI value in the vaginal delivery group was 1.02 ± 0.26 and it was 0.95 ± 0.033 in the caesarean delivery group. The values of SI ((Mean and SD) for ICU admission were (1.23 (± 0.35)), for (MODS) it was (1.47 (± 0.84)), for blood transfusion > 4 units it was (1.15 (± 0.41)), for surgical intervention it was (1.58 (± 0.51)) and for maternal death (1.39 (± 0.85)). SI ≥ 1.4, had sensitivity 26.82% (21.09-33.19); specificity 100%(99.53-100), PPV was 100% and NPV was 82.96%(81.8-84.06)with an AUC of 0.8 (0.78-0.83) on ROC analysis. In subjects with PIH/eclampsia, SI was lower and in patients with severe anemia, SI was higher. SI performed well as a screening tool in the prediction of adverse maternal outcomes. SI ≥ 0.9 was significantly associated with maternal adverse outcomes: ICU admission, MODS, surgical intervention, blood transfusion and death. The study proposes an SI cut-off of 0.9 for referral and a cut-off of 1.1 for intervention in a tertiary care hospital. Patients with PIH/eclampsia tend to have lower mean SI values as compared to the rest of the study population, suggesting that SI may not be a reliable indicator in patients with PIH/eclampsia.

All trauma is not created equal: Redefining severe trauma for combat injuries

Injury severity scores (ISS) and shock index (SI) are popular trauma scoring systems. We assessed ISS and SI in combat trauma to determine the optimal cut-off values for mortality and trauma outcomes. Retrospective analysis of the Department of Defense Trauma Registry, 2008–2016, was performed. Areas under receiver operating characteristic curves (AUROCs) were calculated for ISS and SI on mortality, massive volume transfusion (MVT), and emergent surgical procedure (ESP). Optimal cut-off values were defined using the Youden index (YI). 22,218 patients (97.1% male), median ages 25–29 years, ISS 9.4 ± 0.07, with 58.1% penetrating injury were studied. Overall mortality was 3.4%. AUROCs for ISS on mortality, MVT, and ESP were 0.882, 0.898, and 0.846, while AUROCs for SI were 0.727, 0.864, and 0.711 respectively. The optimal cut-off values for ISS on mortality, MVT, and ESP were 12.5 (YI = 0.634), 12.5 (YI = 0.666), and 12.5 (YI = 0.819), with optimal values for SI being 0.94 (YI = 0.402), 0.88 (YI = 0.608), and 0.81 (YI = 0.345) respectively. Classic values for severe ISS underrepresent combat injury while the SI values defined in this study are consistent with civilian data.

Altered Cerebral Blood Flow and Potential Neuroprotective Effect of Human Relaxin-2 (Serelaxin) During Hypoxia or Severe Hypovolemia in a Sheep Model.

Specific neuroprotective strategies to minimize cerebral damage caused by severe hypoxia or hypovolemia are lacking. Based on previous studies showing that relaxin-2/serelaxin increases cortical cerebral blood flow, we postulated that serelaxin might provide a neuroprotective effect. Therefore, we tested serelaxin in two emergency models: hypoxia was induced via inhalation of 5% oxygen and 95% nitrogen for 12 min; thereafter, the animals were reoxygenated. Hypovolemia was induced and maintained for 20 min by removal of 50% of the total blood volume; thereafter, the animals were retransfused. In each damage model, the serelaxin group received an intravenous injection of 30 µg/kg of serelaxin in saline, while control animals received saline only. Blood gases, shock index values, heart frequency, blood pressure, and renal blood flow showed almost no significant differences between control and treatment groups in both settings. However, serelaxin significantly blunted the increase of lactate during hypovolemia. Serelaxin treatment resulted in significantly elevated cortical cerebral blood flow (CBF) in both damage models, compared with the respective control groups. Measurements of the neuroproteins S100B and neuron-specific enolase in cerebrospinal fluid revealed a neuroprotective effect of serelaxin treatment in both hypoxic and hypovolemic animals, whereas in control animals, neuroproteins increased during the experiment. Western blotting showed the expression of relaxin receptors and indicated region-specific differences in relaxin receptor-mediated signaling in cortical and subcortical brain arterioles, respectively. Our findings support the hypothesis that serelaxin is a potential neuroprotectant during hypoxia and hypovolemia. Due to its preferential improvement of cortical CBF, serelaxin might reduce cognitive impairments associated with these emergencies.

The predictive value of the shock index and modified shock index for the short-term mortality in patients with acute pulmonary embolism

Aim: The purpose of the study was to examine the relationship of shock index (SI) and modified shock index (MSI) with pulmonary embolism severity index (PESI) score in predicting short-term death in acute pulmonary embolism (APE) patients. Material and Methods: This retrospective analysis included 104 consecutive patients whose APE was confirmed using computerized tomographic pulmonary angiography. For each patient, the PESI score, the SI, and the MSI were calculated. The main endpoint of the study was short-term mortality.Results: Patients based on hemodynamic status or the PESI score upon admission were allocated into high risk and non-high risk groups. We noted that SI and MSI were significantly elevated in a high risk group (1.17 ± 0.17 vs. 0.77 ± 0.17 and 1.54 ± 0.29 vs. 1.05 ± 0.21, respectively, p 0.001). In a correlation analysis, we showed that SI and MSI were significantly correlated with the PESI score for short-term mortality (r = 0.491 and r = 0.504, respectively, p 0.001). An area under curve value of SI and MSI for short-term death were 0.66 (0.52-0.79 95% CI, p = 0.022) and 0.67 (0.53-0.80 95% CI, p = 0.026) respectively.Conclusion: The present study findings demonstrated that the SI and MSI may be applicable in predicting short-death in patients with APE.

176: Applications for shock index in obstetrics

Evaluation of post-partum blood loss is traditionally inaccurate. Shock index, a common tool used in the trauma setting to identify patients at risk for massive transfusion, is defined as heart rate divided by systolic blood. Our objective is to evaluate postpartum shock index (SI) values between women who did and did not require blood transfusion due to postpartum hemorrhage (PPH) as a useful tool in obstetrics. This is a retrospective case control study of women who delivered at a single institution in 2018. Delivery data, quantified blood loss (QBL), maternal outcomes data, and vital signs were collected throughout the first 30 minutes postpartum. Primary outcome is to define normal SI at term. Secondary outcomes analyze association between SI and QBL. Analysis was performed using Wilcoxon rank-sum test, and linear, univariate and multivariate regression. Log scaling was applied due to skewness in data. 126 women were studied: 80 experienced PPH and 20 required transfusion. Normal SI at term was 0.7 (Range 0.4-1.1). Increase in SI value was associated with increasing blood loss. For every 0.1 incremental increase in SI, the RR of blood loss was 1.06. SI > 0.9 at 30 minutes postpartum was significantly associated with need for blood transfusion (p 0.003). As a predictor of blood transfusion, this SI 30 minutes postpartum of > 0.9 had PPV value of 26% and NPV of 89%. Increased SI values were associated with greater volume of blood loss and need for blood transfusion in both vaginal and cesarean deliveries. SI predicts need for blood transfusion in women after vaginal or cesarean delivery. SI is positively correlated with intra-partum blood loss. SI is easily obtained and reproducible at the time of delivery. Postpartum SI may be a clinically useful tool in obstetrics.

Shock Index in Patients Presenting With Acute Heart Failure: A Multicenter Multinational Observational Study.

Shock index (SI) has a prognostic role in coronary heart disease; however, data on acute heart failure (AHF) are lacking. We evaluated the predictive values of SI in patients with AHF. Data were retrospectively analyzed from the Gulf Acute Heart Failure Registry. Patients were categorized into low SI versus high SI based on the receiver operating characteristic curves. Primary outcomes included cardiogenic shock (CS) and mortality. Among 4818 patients with AHF, 1143 had an SI ≥0.9. Compared with SI <0.9, patients with high SI were more likely males, younger, and having advanced New York Heart Association class, fewer cardiovascular risk factors and less prehospital β-blockers and angiotensin-converting enzyme inhibitor use. Shock index had significant negative correlations with age, pulse pressure, mean arterial pressure, and left ventricle ejection fraction and had positive correlation with hospital length of stay. Shock index ≥0.9 was significantly associated with higher composite end points, in-hospital, and 3-month mortality. Shock index ≥0.9 had 96% negative predictive value (NPV) and 3.5 relative risk for mortality. Multivariate regression analysis showed that SI was independent predictor of mortality and CS. With a high NPV, SI is a simple reliable bedside tool for risk stratification of patients with AHF. However, this conclusion needs further support.

Shock index and modified shock index as triage screening tools for sepsis

BackgroundFever is one of the common conditions encountered in the emergency department, which related to a spectrum of diseases severity. Identifying sepsis patients from uncomplicated febrile patients is challenging in the emergency triage areas and pre-hospital settings. ObjectivesAssess the triage shock index (SI) and modified shock index (MSI) in febrile patients as predictors for sepsis and sepsis-related outcomes. DesignA retrospective cohort study. SettingPatients presented to the Emergency Department of King Khalid University Hospital. Patients and methodsThe analysis included all febrile adult patients triaged with a temperature of 38 °C or more from January 2016 to December 2017. Based on triage vital sign we calculate the SI with cut-off levels of ≥0.7 and ≥1 and MSI with cut-off levels of ≥1 and ≥1.3. We report the Relative Risk, Sensitivity, Specificity, Positive and Negative Predictive Values of the predictors. Main outcome measuresSepsis and sepsis-related outcomes such as hyperlactatemia, ICU admission, and 28 days mortality. Sample size274 patients. Results274 patients met our inclusion/exclusion criteria. Of the 274 patients, 252 patient (92%) were septic, 62 patients (22%) had hyperlactatemia, 20 patients admitted to the ICU, and 5 patient died within 28 days. An MSI of ≥1 had a sensitivity of 90% for sepsis predication, 85% for ICU admission and 100% for 28 days mortality. MSI of ≥1.3 showed a specificity (59%–100%) for all the outcomes of interest. Non-significant statistical trends of greater accuracy of MSI over SI. ConclusionMSI and SI were found to be promising predictors in triaging febrile patients. However no single cut-off values of MSI or SI were found to have an optimal accuracy for prediction of sepsis and sepsis-related outcomes. Further studies are required to assess the incorporation of MSI in a multi-item scaling system for the prediction of sepsis and its related outcomes. LimitationsSmall single center study and the results may not be generalizable.

Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments

Study objectivesThe shock index (SI), defined as the ratio of the heart rate (HR) to the systolic blood pressure (BP), is used as a prognostic tool in trauma and in...

Shock Index as a Predictor of Post-Intubation Hypotension and Cardiac Arrest; A Review of the Current Evidence

Endotracheal intubation is a lifesaving procedure that is performed in various settings within the hospital or even in the pre-hospital field. However, it can result in serious hemodynamic complications, such as post-intubation hypotension (PIH) and cardiac arrest. The most promising predictor of such complications is the shock index (SI), which holds great prognostic value for multiple disorders. On the other hand, most of the studies that have assessed the predictability of the pre-intubation SI have been small and were limited to a particular setting of a single center; thus, the results were not generalizable, and the predictive value vary according to the setting. This review comprehensively assessed the utility of the pre-intubation SI for predicting PIH and post-intubation cardiac arrest by classifying and comparing evidence compiled from various settings, such as pre-hospital settings, emergency departments (EDs), intensive care units (ICUs), and operating rooms (ORs). The vast majority of these studies, conducted in ED and ICU settings, which revealed a significant correlation between an elevated SI and PIH or post-intubation cardiac arrest. The reliability and simplicity of obtaining a pre-intubation SI value are important considerations that encourage the extension of its use to all in-hospital intubations. Further studies are required to assess the predictive value of the SI in the pre-hospital setting.

Correlation between shock index and severity of septic shock and its prognostic value

To discuss the correlation between shock index (SI) and severity and the values to forecast the prognosis in patients with septic shock. 127 patients with septic shock admitted to intensive care unit (ICU) of Zhejiang Provincial People's Hospital from January 1st, 2016 to October 31st, 2017 were enrolled, and they were divided into survival group and death group according to the outcomes after 28-day hospitalized. The vital signs, laboratory indexes, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), lactate clearance rate (LCR) of 3 hours after fluid resuscitation, and shock index on admission (SI1) and shock index of 3 hours after fluid resuscitation (SI2) were compared between the two groups. The correlation among SI and APACHE II, SOFA, LCR was analyzed. The receiver operating characteristic curve (ROC) was drawn to evaluate the prognostic value of SI in patients with septic shock. A total of 127 patients were included, 52 in survival group (40.9%) and 75 in death group (59.1%). The SI1, SI2, APACHE II and SOFA in the death group were significantly higher than those in the survival group (SI1: 1.62±0.46 vs. 1.35±0.32, SI2: 1.36±0.24 vs. 0.93±0.15, APACHE II: 17.5±4.0 vs. 13.6±3.5,SOFA: 9.5±2.3 vs. 6.3±1.5), and LCR was significantly lower than that in the survival group [(14.4±5.2)% vs. (28.6±8.6)%], with statistically significant differences (all P < 0.01). The correlation analysis showed that SI1 was significantly positively correlated with APACHE II (r = 0.458, P = 0.000) and SOFA (r = 0.535, P = 0.000), SI2 was also significantly positively correlated with APACHE II (r = 0.624, P = 0.000) and SOFA (r = 0.656, P = 0.000), while SI1 and SI2 were significantly negatively correlated with LCR (r values were -0.348, -0.435, both P = 0.000), and the SI2 were more remarkable. ROC curve analysis showed that the area under ROC curve (AUC) of SI1 for predicting the prognosis of septic shock was 0.720 [95% confidence interval (95%CI) = 0.620-0.831, P < 0.05]; when SI1 = 1.68, the sensitivity, specificity, Yoden index, positive predictive value and negative predictive value were 79.5%, 65.6%, 0.451, 0.759 and 0.636, respectively. The AUC of the SI2 to predict prognosis of septic shock was 0.826 (95%CI = 0.739-0.826, P < 0.05); when SI2 = 1.37, the sensitivity, specificity, Yoden index, positive predictive value and negative predictive value were 85.7%, 87.6%, 0.733, 0.893 and 0.902, respectively. Compared with SI1, SI2 was more correlated with the severity in patients with septic shock and it had more values to predict prognosis.

Shock Index-A Useful Noninvasive Marker Associated With Age-Specific Early Mortality in Children With Severe Sepsis and Septic Shock: Age-Specific Shock Index Cut-Offs

Aim of the study was to analyze the association of shock index (SI) from 0 to 6 hours with early mortality in severe sepsis/septic shock and to explore its age-specific cut-off values. To investigate association of change in SI over first 6 hours with early mortality. A prospective cohort study of children (<14 years) admitted in emergency department, tertiary care hospital with severe sepsis or septic shock, divided into 3 groups: group 1: 1 month to <1 year; group 2: 1 to <6 years; group 3: 6 to 12 years. Shock index (SI = heart rate/systolic blood pressure) measured at admission (X0) and hourly till 6 hours (X1-6). Primary outcome was death within 48 hours of admission. Area under receiver operating characteristic curves were constructed for SI (0-6). Optimal cut-offs of SI 0 and SI 6, maximizing both sensitivity and specificity were determined and positive and negative predictive values (PPV, NPV) were calculated. From 2015 to 2016, 120 children were recruited. Septic shock was present at admission in 56.7% children. Early mortality was 50%. All hourly shock indices (SI 0-6) were higher among nonsurvivors in group 2 (P ≤ .03) and group 3 (P < .001). In group 1, SI after 2 hours was higher in nonsurvivors (P 2-6: ≤ .02). Area under receiver operating characteristic curves (95% CI) for SI at 0 hour was 0.72 (0.5-0.9), 0.66 (0.5-0.8), and 0.77 (0.6-0.9) and at 6 hours was 0.8 (0.6-1), 0.75 (0.6-0.9), and 0.8 (0.7-1) in 3 groups. The cut-off values of SI 0 (sensitivity; specificity; PPV; NPV) in 3 groups: 1.98 (77; 75; 67; 83), 1.50 (65; 65; 68; 63), and 1.25 (90; 67; 77; 83) and SI6: 1.66 (85; 80; 73; 89), 1.36 (73; 70; 73; 70), and 1.30 (74; 73; 78; 69). Improvement of SI over 6 hours was associated with better outcome. Children with higher SI at both time points had higher mortality than those with SI score below the cut-offs (P = .001). Age-specific SI cut-off values may identify children at high risk of early mortality in severe sepsis/septic shock and allow for better targeted management.

The value of shock index in prediction of cardiogenic shock developed during primary percutaneous coronary intervention

BackgroundShock index(SI) is a conventional predictive marker for haemodynamic state. Its breakpoint varies by different conditions according to previous studies. The current study was performed to evaluate the capability of SI in prediction of cardiogenic shock(CS) developed during primary percutaneous coronary intervention (pPCI).MethodsTotal 870 patients of ST segment elevation myocardial infarction(STEMI) who were haemodynamic stable before pPCI were involved in the study. In this cohort, 625 consecutive patients composed analysis series and 245 consecutive patients composed validation series. Multivariate regression analysis was used to evaluate whether SI was a significant predictor of developed CS and Hosmer-Lemeshow test was used to assess the goodness of model fitness. Receiver-operating characteristics (ROC) analysis was used to compare the predictive capability of SI with other predictors. The sensitivity, specificity, accuracy, positive and negative predictive values of SI at different cutoff values was compared to identify a best breakpoint.ResultsIn the analysis series, SI and Killips classification were identified as independent predictors. ROC analysis demonstrated the diagnostic capability of SI was superior to pre-procedural systolic blood pressure(SBP) or heart rate(HR) alone (0.8113 vs 0.7582, P = 0.04 and 0.8113 vs 0.7111, P < 0.001). The diagnostic capability of SI was equivalent to that of combination of SBP, HR and Killips claasification(0.8133 vs 0.8137, P = 0.97). SI had a high specificity and low sensitivity. When the cutoff value was set at 0.93, the positive predictive value, negative predictive value and diagnostic accuracy was 42.6%, 95.1% and 87.4% respectively. In validation series, the area under ROC curve was 0.8245, which was similar to that in the analysis series. The positive predictive value, negative predictive value and diagnostic accuracy at the cutoff value of 0.93 was 53.8%, 93.2% and 88.9% respectively.ConclusionsSI has a high predictive accuracy for developing CS during pPCI in STEMI patients. It is an excellent exclusion diagnosis index rather than confirmative diagnosis index.

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

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.

To Study the Prognostic Value of Shock Index in Patients Presenting with Severe Sepsis and Septic Shock

To Study the Prognostic Value of Shock Index in Patients Presenting with Severe Sepsis and Septic Shock

Case-control study of shock index among women who didand did not receive blood transfusions due to postpartumhemorrhage.

To compare shock index (SI) values between women who required blood transfusion due to postpartum hemorrhage (PPH) and women who did not. In a case-control study, clinical data were assessed from the medical records of women requiring blood transfusion for PPH at a center in Brazil between 2012 and 2015 (n=105). A control group was randomly selected from women who did not receive blood transfusion (n=129). Compared with women who did not receive a transfusion after delivery, women who did receive one had significantly higher SI values 10minutes after delivery (0.81±0.27 vs 0.72±0.16; P=0.012), at 30minutes (0.83±0.26 vs 0.71±0.15; P<0.001), and at 2hours (0.84±0.27 vs 0.70±0.14; P=0.032). For vaginal deliveries, SI values were significantly different at 30 minutes (0.88±0.26 vs 0.71±0.14; P<0.001) and 2hours (0.90±0.23 vs 0.72±0.14; P=0.001). No significant differences were found for cesarean delivery. The SI might be useful to identify early vital sign changes due to PPH. Increased SI values were associated with need for transfusion in vaginal deliveries.

Age Shock Index is Superior to Shock Index and Modified Shock Index for Predicting Long-Term Prognosis in Acute Myocardial Infarction.

Shock index (SI) has been reported to help us predict adverse prognosis in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). However, the prognostic value of age SI and modified shock index (MSI) in AMI undergoing PCI is unknown. Moreover, the prognostic performance of admission age SI is not compared with SI, MSI, and the Global Registry of Acute Coronary Events (GRACE) risk score. One thousand eight hundred sixty-four AMI patients undergoing PCI were analyzed in a retrospective cohort study. Clinical endpoint was all-cause mortality. The predictive performance of new models was assessed by C-statistic, Hosmer-Lemeshow test, Nagelkerke-R, Brier scores, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Multivariate analysis showed that higher age SI and MSI were both associated with a higher rate of all-cause mortality [age SI: hazard ratios (HR) = 1.025, 95% CI = 1.010-1.040, P = 0.001; MSI: HR = 2.902, 95% CI = 1.180-7.137, P = 0.020]. The prognostic performance of admission age SI was similar to the GRACE systems for predicting all-cause mortality (C-statistic: z = 0.437, P = 0.662; IDI: -0.005, P = 0.474; NRI: -0.028, P = 0.257), but better than admission SI (C-statistic: z = 3.944, P < 0.001; IDI: 0.012, P = 0.016; NRI: 0.472, P < 0.001) and admission MSI (C-statistic: z = 3.214, P = 0.001; IDI: 0.011, P = 0.001; NRI: 0.561, P < 0.001). Age SI alone can identify patients at high risk of death in AMI patients undergoing PCI. It is similar to GRACE but better than SI and MSI for predicting all-cause mortality. However, age SI is easier to calculate than GRACE.

Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management—Part II

PurposeOur primary aim was to identify predictors of immediate hemodynamic decompensation during the peri-intubation period. MethodsWe conducted a nested case-control study of a previously identified cohort of adult patients needing intubation admitted to a medical-surgical ICU during 2013–2014. Hemodynamic derangement was defined as cardiac arrest and/or the development of systolic blood pressure <90mmHg and/or mean arterial pressure <65mmHg 30min following intubation. Data during the peri-intubation period was analyzed. ResultsThe final cohort included 420 patients. Immediate hemodynamic derangement occurred in 170 (40%) patients. On multivariate modeling, age/10year increase (OR 1.20, 95% CI 1.03–1.39, p=0.02), pre-intubation non-invasive ventilation (OR 1.71, 95% CI 1.04–2.80, p=0.03), pre-intubation shock index/1 unit (OR 5.37 95% CI 2.31–12.46, p≤0.01), and pre-intubation modified shock index/1 unit (OR 2.73 95% CI 1.48–5.06, p≤0.01) were significantly associated with hemodynamic derangement. Those experiencing hemodynamic derangement had higher ICU [47 (28%) vs. 33 (13%); p≤0.001] and hospital [69 (41%) vs. 51 (20%); p≤0.001] mortality. ConclusionsHemodynamic derangement occurred at a rate of 40% and was associated with increased mortality. Increasing age, use of non-invasive ventilation before intubation, and increased pre-intubation shock and modified shock index values were significantly associated with hemodynamic derangement post-intubation.

Standing shock index: An alternative to orthostatic vital signs

ObjectiveThe lack of a sensitive, practical bedside test for hypovolemia has rekindled interest in the shock index (heart rate divided by systolic blood pressure). Here, we compare the effect of blood donation on standing shock index values with its effect on values for the supine shock index and orthostatic change in shock indicies (OCSI). MethodsThis is a re-analysis of data collected for an earlier report. Data were available from 292 adults below age 65 and 44 adults ages 65 and over, donating 450mL of blood. We obtained supine and standing vital signs before and after donation and then calculated 95% confidence intervals for differences based on the t-distribution. ResultsBlood donation resulted in a mean increase in the standing shock index of 0.09 [95% CI, 0.08–0.11] in younger adults and 0.08 [95% CI, 0.05–0.11] in older adults. These changes were similar to those noted for OCSI (young, 95% CI, 0.08–0.10; old, 95% CI, 0.04–0.10). Supine shock index values did not change with donation in younger donors (mean difference 0.0 [95% CI, 0.0–0.01]) or older donors (mean difference 0.0 [95% CI, −0.01–0.03]). ConclusionBlood donation does not affect the supine shock index, but it does result in changes in standing shock index that are similar to changes in more complicated orthostatic vital signs.