Shock index as a predictor of vasopressor use in patients with sepsis
DOI:
https://doi.org/10.18203/2349-3933.ijam20193624Keywords:
Heart rate, Shock index, Sepsis, Systolic blood pressureAbstract
Background: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis and septic shock are major healthcare problems affecting millions of people around the world each year and killing as many as one in four. The documented incidence of sepsis worldwide is 1.8 million each year with mortality rate of almost 30%. Sepsis is the 10th leading cause of death in the United States. Shock index (SI) is defined as “Heart rate divided by Systolic blood pressure (HR/SBP)”. Normal range is 0.5 to 0.7 in healthy adults.
Methods: A Prospective study was conducted between August 2018 to March 2019 comprising of 100 consecutive patients presenting to emergency department and ICU with sepsis. Subjects were identified by having evidence of infection presenting with cardiovascular collapse or organ failure with help of q-SOFA(quick- sepsis related organ failure assessment ) and SOFA scores (sequential organ failure assessment score).Cases with clear alternative diagnosis were excluded. Vital signs were recorded, and Shock index was calculated. Primary outcome, which was use of Vasopressor therapy was analysed.
Results : A Total of 100 cases were studied, of which 70 patients were males and 30 females with mean age of 48.5 ±16.2 yrs. Most of the cases were between 35 to 60 years. Patients were classified into 3 categories based on shock index:1. <0.8 (normal, n=16) 2. 0.8 to <1.2 (n=29) 3. >1.2 (n=55). The use of vasopressor therapy within first 24 hours for each group was 18%, 34%, and 78%. This difference was statistically significant (p=<0.05).
Conclusion : In patients with sepsis an elevated shock index was indicator of early vasopressor therapy in the first 24hours. It is a simple bedside tool to identify septic patients in need for early vasopressor therapy thereby preventing further clinical deterioration.
References
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Int care med. 2017 Mar 1;43(3):304-77.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001 Jul 1;29(7):1303-10.
Hoyert DL, Anderson RN. Age-adjusted death rates: trend data based on the year 2000 standard population. National vital statistics reports. 2001 Sep 21;49(9).
Melamed A, Sorvillo FJ. The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Critical care. 2009 Feb;13(1):R28.
Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A. Shock index and early recognition of sepsis in the emergency department: pilot study. Western Journal of Emergency Medicine. 2013 Mar;14(2):168
King RW, Plewa MC, Buderer NM, Knotts FB. Shock index as a marker for significant injury in trauma patients. Academic Emergency Medicine. 1996 Nov;3(11):1041-5.
Rady MY. The role of Central Venous Oximetry, lactic acid concentration and shock index in the evaluation of clinical shock: a review. Resuscitation. 1992;24:55.
Marik PE, Taeb AM. SIRS, qSOFA and new sepsis definition. Journal of thoracic disease. 2017 Apr;9(4):943.
Asaari H. Value of shock index in prognosticating the short term outcome of death for patients presenting with severe sepsis and septic shock in the emergency department. Med J Malaysia. 2012 Aug;67(4):407.
Wira CR, Francis MW, Bhat S, Ehrman R, Conner D, Siegel M. The shock index as a predictor of vasopressor use in emergency department patients with severe sepsis. Western J Emergency Med. 2014 Feb;15(1):60.
Ho BC, Bellomo R, Mc Gain F, Jones D, Naka T Wan L, et al. The incidence and outcome of septic shock patients in the absence of early-goal directed therapy. Crit Care. 2006 Jun;10(3):R80.
Berger T, Green J, Horeczko T, et al. Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med. 2013;14:168-74.
Yussof SJ, Zakaria MI, Mohamed FL, Bujang MA, Lakshmanan S, Asaari AH. Value of shock index in prognosticating the short term outcome of death for patients presenting with severe sepsis and septic shock in the emergency department. Med J Malaysia 2012;67(4):406–11.
Mann B, Hough C, Carlbom D. Shock Index as a Predictor of Hospital Outcomes in Patients with Sepsis. Chest. 2015 Oct 1;148(4):350A.
Kenzaka T, Okayama M, Kuroki S, Fukui M, Yahata S, Hayashi H, et al. Importance of vital signs to the early diagnosis and severity of sepsis: association between vital signs and sequential organ failure assessment score in patients with sepsis. Intern Med 2012;51(8):871-6.
