Utility of Shock Indexes in Predicting Early Results of Septic Shock Patients in Intensive Care Unit
Abstract
Objectives: Some parameters are currently being used in Intensive Care Units (ICU) in order to predict the mortality. In our study, we aimed to determine the usability of shock index (SI), modified shock index (MSI) and age shock index (ASI) in order to predict the clinical outcomes and mortality of patients with sepsis and septic shock.
Study Design: We retrospectively evaluated the results of patients who were hospitalized in ICU, between January 1, 2018 and December 31, 2018.
Patients and Methods: Age, gender, co-morbidities, acute physiology and chronic health evaluation II (APACHE II) scores, length of mechanical ventilation, length of hospital stay, SI, MSI, ASI and mortalitywere recorded in patients with sepsis..
Results:We evaluated 172 patients with sepsis. SI, MSI, ASI levels were significantly higher in patients with mortality (p < 0.05). For SI, the area under the receiver operating characteristic (ROC) curve was 0.649 (95% CI = 0.573–0.720, p = 0.0003) and cutoff value for shock index was 1.06 (sensitivity: 62%, 95% CI: 51-72.3; specificity: 67.44%, 95% CI: 56.5-77.2). For MSI, the area under the ROC curve was 0.585 (95% CI = 0.508–0.659, p = 0.049) and cutoff value was 1.69 (sensitivity: 37.9%, 95% CI: 27.7-49; specificity: 82.5%, 95% CI: 72.9-89.9). For ASI, the area under the ROC curve was 0.613 (95% CI = 0.536–0.686, p = 0.0078) and cutoff value was 87.42 (sensitivity: 40.2%, 95% CI: 29.9–51.3; specificity: 82.56%, 95% CI: 72.9–89.9).
Conclusion: The shock indexes were found out to be significant in predicting mortality in septic patients. While the sensitivity was limited in 3 shock indexes, specificity was determined significantly higher in ASI and MSI with significantly lower in SI.
References
- 1. Sakr Y, Jaschinski U, Wittebole X, Szakmany T, Lipman J, Ñamendys-Silva SA, et al. Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit. Open Forum Infect Dis 2018;5:ofy313.
- 2. Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A, et alShock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med 2013;14:168-74.
- 3. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief. 2011;1-8.
- 4. Ogura T, Nakamura Y, Takahashi K, Nishida K, Kobashi D, Matsui S. Treatment of patients with sepsis in a closed intensive care unit is associated with improved survival: a nationwide observational study in Japan. J Intensive Care 2018;6:57.
- 5. Smischney NJ, Seisa MO, Heise KJ, Schroeder DR, Weister TJ, Diedrich DA. Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically Ill. J Intensive Care Med 2018;33:582-588.
- 6. Trivedi S, Demirci O, Arteaga G, Kashyap R, Smischney NJ. Evaluation of preintubation shock index and modified shock index as predictors of postintubation hypotension and other short-term outcomes. J Crit Care 2015;30:861.e1-7.
- 7. Torabi M, Moeinaddini S, Mirafzal A, Rastegari A, Sadeghkhani N. Shock index, modified shock index, and age shock index for prediction of mortality in Emergency Severity Index level 3. Am J Emerg Med 2016;34:2079-2083.
- 8. Jayaprakash N, Gajic O, Frank RD, Smischney N. Elevated modified shock index in early sepsis is associated with myocardial dysfunction and mortality. J Crit Care 2018;43:30-35.
- 9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.
- 10. Allgower M, Burri C. “Shock index”. Dtsch Med Wochenschr 1967;92:1947–50.
- 11. Liu YC, Liu JH, Fang ZA, Shan GL, Xu J, Qi ZW, et al. Modified shock index and mortality rate of emergency patients. World J Emerg Med 2012;3:114-7.
- 12. Yu T, Tian C, Song J, He D, Sun Z, Sun Z. Age Shock Index is Superior to Shock Index and Modified Shock Index for Predicting Long-Term Prognosis in Acute Myocardial Infarction. Shock 2017;48:545-550.
- 13. Tseng J, Nugent K. Utility of the shock index in patients with sepsis. Am J Med Sci 2015;349:531-5.
- 14. 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;51:871-6.
- 15. 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;67:406-11.
- 16. Singh A, Ali S, Agarwal A, Srivastava RN. Correlation of shock index and modified shock index with the outcome of adult trauma patients: a prospective study of 9860 patients. N Am J Med Sci 2014;6:450-2.
- 17. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580-637.
- 18. Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma 2009;67:1426-30.
- 19. Shangguan Q, Xu JS, Su H, Li JX, Wang WY, Hong K, et al. Modified shock index is a predictor for 7-day outcomes in patients with STEMI. Am J Emerg Med 2015;33:1072-5.
- 20. Bruijns SR, Guly HR, Bouamra O, Lecky F, Lee WA. The value of traditional vital signs, shock index, and age-based markers in predicting trauma mortality. J Trauma Acute Care Surg 2013;74:1432-7.
- 21. Zarzaur BL, Croce MA, Fischer PE, Magnotti LJ, Fabian TC. New vitals after injury: shock index for the young and age x shock index for the old. J Surg Res 2008;147:229-36.
- 22.Lee Y, Kim SJ, Kim YS, Kim H, Lee DK, Lee J, et al. The usefulness of the SOFA and APACHE II scoring systems for the early prediction of mortality in patients with dapsone poisoning. Hum Exp Toxicol. 2019;38:280-287.
Yoğun Bakım Ünitesindeki Septik Şok Hastalarında Şok İndekslerinin Erken Dönem Sonuçları Öngörmede Kullanılabilirliği
Abstract
Amaç: Yoğun Bakım Ünitesinde (YBÜ) mortaliteyi ön görmek için bazı parametreler kullanılmaktadır. Çalışmamızda YBÜ’ye yatan sepsis ve septik şoktaki hastalarda şok indeksi (SI), modifiye şok indeksi (MSI) ve yaş şok indeksinin (YSI) hastaların klinik sonuçlarını ve mortaliteyi ön görmede kullanılabilirliğinin araştırılması amaçlanmıştır.
Çalışma Planı:Çalışmamız Anesteziyoloji ve Yoğun Bakım Ünitesi Kliniğinde 1 Ocak 2018 ile 31 Aralık 2018 tarihleri arasında retrospektif hasta verileri değerlendirilerek yapıldı.
Hastalar ve Yöntemler:Sepsis hastalarınının yaşları, cinsiyetleri, eşlik eden hastalıkları, akut fizyoloji ve kronik sağlık değerlendirme II (APACHE II) skoru, mekanik ventilasyon süresi, yatış süresi, SI, MSI, YSI ve mortalite verileri kayıt edildi.
Bulgular: Çalışmaya 172 sepsis hastası dahil edildi. Mortalite olan hastalarda SI, MSI ve YSI anlamlı yüksek bulundu (p<0,05). SI için ROC eğrisi altındaki alan 0,649'dur (% 95 güven aralığı (GA): 0,573 - 0,720 P = 0,0003). Mortalite için eşik değeri 1,06’dır (duyarlılık: %62, %95 GA: 51-72,3, özgüllük: %67,44, %95 GA: 56,5-77,2). MSI için ROC eğrisi altındaki alan 0,585’tir (% 95 GA: 0,508 – 0,659 P = 0,049). Mortalite için eşik değeri 1,69’dur (duyarlılık: %37,9 %95 GA: 27,7 – 49, özgüllük: %82,5, %95 GA: 72,9 – 89,9). YSI için ROC eğrisi altındaki alan 0,613'tür (% 95 GA: 0,536 - 0,686 P = 0,0078). Mortalite için eşik değeri 87,42’dir (duyarlılık: %40,2, %95 GA: 29,9-51,3, özgüllük: %82,56, %95 GA: 72,9-89,9).
Sonuç: Sepsis hastalarında şok indeksleri mortaliteyi ön görmesi açısından anlamlı bulundu. Ancak duyarlılık üç şok indeksininde sınırlıyken, özgüllük açısından YSI ve MSI yüksek anlamlı, SI daha düşük anlamlı bulundu.
References
- 1. Sakr Y, Jaschinski U, Wittebole X, Szakmany T, Lipman J, Ñamendys-Silva SA, et al. Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit. Open Forum Infect Dis 2018;5:ofy313.
- 2. Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A, et alShock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med 2013;14:168-74.
- 3. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief. 2011;1-8.
- 4. Ogura T, Nakamura Y, Takahashi K, Nishida K, Kobashi D, Matsui S. Treatment of patients with sepsis in a closed intensive care unit is associated with improved survival: a nationwide observational study in Japan. J Intensive Care 2018;6:57.
- 5. Smischney NJ, Seisa MO, Heise KJ, Schroeder DR, Weister TJ, Diedrich DA. Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically Ill. J Intensive Care Med 2018;33:582-588.
- 6. Trivedi S, Demirci O, Arteaga G, Kashyap R, Smischney NJ. Evaluation of preintubation shock index and modified shock index as predictors of postintubation hypotension and other short-term outcomes. J Crit Care 2015;30:861.e1-7.
- 7. Torabi M, Moeinaddini S, Mirafzal A, Rastegari A, Sadeghkhani N. Shock index, modified shock index, and age shock index for prediction of mortality in Emergency Severity Index level 3. Am J Emerg Med 2016;34:2079-2083.
- 8. Jayaprakash N, Gajic O, Frank RD, Smischney N. Elevated modified shock index in early sepsis is associated with myocardial dysfunction and mortality. J Crit Care 2018;43:30-35.
- 9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.
- 10. Allgower M, Burri C. “Shock index”. Dtsch Med Wochenschr 1967;92:1947–50.
- 11. Liu YC, Liu JH, Fang ZA, Shan GL, Xu J, Qi ZW, et al. Modified shock index and mortality rate of emergency patients. World J Emerg Med 2012;3:114-7.
- 12. Yu T, Tian C, Song J, He D, Sun Z, Sun Z. Age Shock Index is Superior to Shock Index and Modified Shock Index for Predicting Long-Term Prognosis in Acute Myocardial Infarction. Shock 2017;48:545-550.
- 13. Tseng J, Nugent K. Utility of the shock index in patients with sepsis. Am J Med Sci 2015;349:531-5.
- 14. 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;51:871-6.
- 15. 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;67:406-11.
- 16. Singh A, Ali S, Agarwal A, Srivastava RN. Correlation of shock index and modified shock index with the outcome of adult trauma patients: a prospective study of 9860 patients. N Am J Med Sci 2014;6:450-2.
- 17. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580-637.
- 18. Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma 2009;67:1426-30.
- 19. Shangguan Q, Xu JS, Su H, Li JX, Wang WY, Hong K, et al. Modified shock index is a predictor for 7-day outcomes in patients with STEMI. Am J Emerg Med 2015;33:1072-5.
- 20. Bruijns SR, Guly HR, Bouamra O, Lecky F, Lee WA. The value of traditional vital signs, shock index, and age-based markers in predicting trauma mortality. J Trauma Acute Care Surg 2013;74:1432-7.
- 21. Zarzaur BL, Croce MA, Fischer PE, Magnotti LJ, Fabian TC. New vitals after injury: shock index for the young and age x shock index for the old. J Surg Res 2008;147:229-36.
- 22.Lee Y, Kim SJ, Kim YS, Kim H, Lee DK, Lee J, et al. The usefulness of the SOFA and APACHE II scoring systems for the early prediction of mortality in patients with dapsone poisoning. Hum Exp Toxicol. 2019;38:280-287.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | April 1, 2021 |
| Submission Date | July 25, 2019 |
| Published in Issue | Year 2021 |