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Shock Index and Outcomes in Patients Admitted to the ICU With Sepsis FREE TO VIEW

Isaac Biney, MBChB; April Shepherd, MBBS; Joylene Thomas, MD; Alem Mehari, MD
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Howard University Hospital, District Heights, MD

Chest. 2015;148(4_MeetingAbstracts):337A. doi:10.1378/chest.2281151
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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: Severe sepsis remains a major cause of death in hospitals across the United States despite advances in care. The Shock Index (SI), defined as the heart rate divided by the systolic blood pressure, has been studied in the emergency department and has been shown to correlate with short term cardiovascular collapse and organ failures in patients presenting with severe sepsis. In this study, we evaluated if a sustained SI elevation correlates with morbidity and mortality in patients with sepsis admitted to the Intensive Care Unit (ICU).

METHODS: The study was a retrospective single-center study conducted in the ICU of a tertiary hospital. Patients admitted to the ICU with sepsis were included. Vital signs were collected at 4-hourly intervals from admission to discharge from the ICU and the SI was calculated for each set of vitals. We defined a sustained SI elevation as having an SI greater than 0.7 for at least 50% of the readings.

RESULTS: A total of 66 patients were studied with 45(68%) patients having a sustained SI elevation. Forty eight percent were male and 86% were African Americans with mean age of 61±15 years. Compared to those without sustained SI elevation, patients with a sustained SI elevation were younger (58±16 vs. 68±11years; p=0.04). There were a total of 16 (24.2%) deaths. ICU mortality was higher in patients with a sustained SI elevation compared to patients without a sustained SI elevation (33% vs. 4.8%; p=0.013). Compared to non-sustained SI elevation group, the sustained SI elevation group had a higher mean number of organ failures (5±2.3 vs.3.5±2.2; p=0.022). There was no difference in the mean APACHE II score between the two groups (21.50±7.37 vs.20.38± 5.47; p=0.567). There was also no difference in the incidence of new onset arrhythmias (46.6% vs. 28.6; p=0.16) or the use of negative chronotropic therapy (47.6% vs. 47.6%; p=1) between the two groups.

CONCLUSIONS: A sustained elevation of the SI is associated with increased morbidity and mortality in patients admitted to the ICU with severe sepsis

CLINICAL IMPLICATIONS: Incorporating this measure in the management of such patients may help improve outcomes; however, larger randomized controlled trials may be needed.

DISCLOSURE: The following authors have nothing to disclose: Isaac Biney, April Shepherd, Joylene Thomas, Alem Mehari

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