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Shock Index as a Predictor of Hospital Outcomes in Patients With Sepsis FREE TO VIEW

Blake Mann, MD; Catherine Hough, MD; David Carlbom, MD
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University of Washington, Seattle, WA

Chest. 2015;148(4_MeetingAbstracts):350A. doi:10.1378/chest.2265483
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: An elevated shock index (heart rate divided by systolic blood pressure) has been shown to predict lactic acidosis, 28-day mortality, and need for vasopressor therapy, and has been proposed as a simple tool to identify septic patients at risk for clinical deterioration. We hypothesized that in patients who present to the emergency department with severe sepsis or septic shock, an elevated shock index after initial fluid resuscitation may predict need for vasopressor therapy and in-hospital mortality.

METHODS: We conducted a single-center retrospective review between June 2013 and September 2014 comprised of patients presenting to a public academic hospital ED. Subjects were identified by a computerized algorithm to detect the following: at least 2 SIRS criteria, suspected infection, and either hypotension or lactate > 4 after 2L of IV fluid resuscitation. Cases with clear alternative diagnoses were excluded. Vital signs were recorded after 2 liters of IV fluid were administered and used to calculate shock index. Primary outcomes were in-hospital mortality and use of vasopressor therapy within 24 hours, which were analyzed using chi-squared testing and multivariable logistic regression.

RESULTS: 217 cases met inclusion criteria. We divided shock index into 3 categories chosen a priori: <0.8 (normal, n=31), 0.8 to <1.2 (n=102), and >1.2 (n=84). Mortality for each group was 19%, 24%, and 33% respectively (p=0.20). In multivariable logistic regression adjusting for age and sex, there was no significant increase in the odds of death for patients in the intermediate (OR 1.37, CI 0.48 - 3.90) or highest (OR 2.24, CI 0.79 - 6.38) category of shock index, compared with those in the normal category. The use of vasopressor therapy within 24 hours for each group was 52%, 57%, and 73%; this difference was statistically significant (p=0.04).

CONCLUSIONS: In patients who presented to the ED with signs concerning for sepsis, an elevated shock index of > 1.2 was significantly associated with increased use of vasopressor therapy in the first 24 hours. Our study was underpowered to detect a difference in mortality

CLINICAL IMPLICATIONS: Shock index is a readily available measure that can be quickly and automatically calculated. A shock index of >1.2 after 2L of fluid resuscitation may be useful to alert care providers of patients at higher risk for clinical deterioration. Further studies may help clarify the role of shock index in initial evaluation of patients with sepsis.

DISCLOSURE: The following authors have nothing to disclose: Blake Mann, Catherine Hough, David Carlbom

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