The clinical utility of shock index in hospitalised patients requiring activation of the rapid response team

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care Pub Date : 2024-12-16 DOI:10.1016/j.aucc.2024.101150

Hasan M. Al-Dorzi MD , Yasser A. AlRumih MBBS , Mohammed Alqahtani MBBS , Mutaz H. Althobaiti MBBS , Thamer T. Alanazi MD , Kenana Owaidah MBBS , Saud N. Alotaibi MBBS , Monirah Alnasser MBBS, MPH , Abdulaziz M. Abdulaal MBBS , Turki Z. Al Harbi MBBS , Ahmad O. AlBalbisi MBBS , Saad Al-Qahtani MD , Yaseen M. Arabi MD, FCCP, FCCM, ATSF

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引用次数: 0

Abstract

Background

The systolic shock index (SSI) is used to direct management and predict outcomes, but its utility in patients requiring rapid response team (RRT) activation is unclear.

Objectives

We explored whether SSI can predict the outcomes of ward patients experiencing clinical deterioration and compared its performance with other parameters.

Methods

This retrospective study included adult patients in medical/surgical wards who required RRT activation. We calculated SSI (heart rate/systolic blood pressure [BP]), diastolic shock index (DSI, heart rate/diastolic BP), modified shock index (heart rate/mean BP), and quick Sequential Organ Failure Assessment (qSOFA) score at activation. We categorised patients into two groups (SSI: ≥1.0 and <1.0). We performed univariate and multivariable logistic regression analyses to evaluate the association of SSI with intensive care unit (ICU) admission, vasopressor therapy, and in-hospital mortality. The covariates included demographics, comorbidities, and reasons for RRT activation.

Results

Among the 837 study patients, 297 (35.5%) had an SSI ≥1.0. On univariate analysis, SSI was associated with vasopressor therapy (odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.40–2.99) but not ICU admission or in-hospital mortality. On multivariable logistic regression analysis, an SSI ≥1.0 was associated with ICU admission (adjusted OR: 1.55, 95% CI: 1.05–2.28), vasopressor therapy (adjusted OR: 3.05, 95% CI: 1.86–5.00), and in-hospital mortality (adjusted OR: 2.18, 95% CI: 1.42–3.33). A systolic BP <90 mmHg, mean BP < 65 mmHg, and qSOFA score ≥2 were associated with these outcomes in univariate and multivariable regression analyses (adjusted ORs close to those of SSI). Separate receiver operating characteristic curve analysis found that SSI, diastolic shock index, and modified shock index poorly discriminated between survivors and nonsurvivors (area under the curve: <0.60 for all).

Conclusions

In ward patients experiencing clinical deterioration, an SSI ≥1.0 was associated with adverse outcomes but did not perform better than systolic and mean BP and qSOFA. This limits its standalone clinical utility in these patients.

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需要启动快速反应小组的住院病人休克指数的临床实用性。

背景：收缩期休克指数（SSI）用于指导治疗和预测预后，但其在需要快速反应小组（RRT）激活的患者中的应用尚不清楚。目的：我们探讨SSI是否可以预测病房患者临床恶化的结局，并将其与其他参数进行比较。方法：这项回顾性研究纳入了需要激活RRT的内科/外科病房的成年患者。我们计算了激活时的SSI（心率/收缩压[BP]）、舒张期休克指数（DSI，心率/舒张压）、修正休克指数（心率/平均BP）和快速序事性器官衰竭评估（qSOFA）评分。我们将患者分为两组（SSI≥1.0）。结果：在837例研究患者中，297例（35.5%）的SSI≥1.0。在单因素分析中，SSI与血管加压治疗相关（优势比[OR]: 2.04, 95%可信区间[CI]: 1.40-2.99），但与ICU入院率或住院死亡率无关。在多变量logistic回归分析中，SSI≥1.0与ICU住院（校正OR: 1.55, 95% CI: 1.05-2.28）、血管加压药物治疗（校正OR: 3.05, 95% CI: 1.86-5.00）和住院死亡率（校正OR: 2.18, 95% CI: 1.42-3.33）相关。结论：在经历临床恶化的病房患者中，SSI≥1.0与不良结局相关，但并不比收缩压、平均血压和qSOFA表现更好。这限制了其在这些患者中的独立临床应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.