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
- Author:
Shah Jahan Mohd Yussof
;
Mohd Idzwan Zakaria
;
Fatahul Laham Mohamed
;
Mohamad Adam Bujang
;
Sharmila Lakshmanan
;
Abu Hassan Asaari
- Publication Type:Journal Article
- From:
The Medical Journal of Malaysia
2012;67(4):406-411
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: The importance of early recognition and
treatment of sepsis and its effects on short-term survival
outcome have long been recognized. Having reliable
indicators and markers that would help prognosticate the
survival of these patients is invaluable and would
subsequently assist in the course of effective dynamic
triaging and goal directed management.
Study Objectives: To determine the prognosticative value of
Shock Index (SI), taken upon arrival to the emergency
department and after 2 hours of resuscitation on the shortterm outcome of severe sepsis and septic shock patients.
Methodology: This is a retrospective observational study
involving 50 patients admitted to the University of Malaya
Medical Centre between June 2009 and June 2010 who have
been diagnosed with either severe sepsis or septic shock.
Patients were identified retrospectively from the details
recorded in the registration book of the resuscitation room. 50 patients were selected for this pilot study. The population comprised 19 males (38%) and 31 females (62%). The median (min, max) age was 54.5 (17.0, 84.0) years. The
number of severe sepsis and septic shock cases were 31
(62%), and 19 (38%) respectively. There were 17 (34%) cases
of pneumonias, 13 (26%) cases of urological sepsis, 8 (16%)
cases of gastro intestinal tract related infections and 12
(24%) cases of other infections. There were a total of 23
(46%) survivors and 27 (54%) deaths. The value of the shock
index is defined as systolic blood pressure divided by heart rate was calculated. Shock Index on presentation to ED (SI 1) and after 2 hours of resuscitation in the ED (SI 2). The median, minimum and maximum variables were tested using Mann-Whitney U and Chi square analysis. The significant parameters were re-evaluated for sensitivity, specificity and cut-off points. ROC curves and AUC values were generated among these variables to assess prognostic utility for outcome.
Results: Amongst all 7 variables tested, 2 were tested to be significant (p: < 0.05). From the sensitivity, specificity and ROC analysis, the best predictor for death was (SI 2) with a sensitivity of 80.8%, specificity of 79.2%, AUC value of 0.8894 [CI95 0.8052, 0.9736] at a cut-off point of ≥1.0.
Conclusion: (SI 2) may potentially be utilized as a reliable predictor for death in patients presenting with septic shock and severe sepsis in an emergency department. This parameters should be further analyzed in a larger scale prospective study to determine its validity.
