SHOCK INDEX AS A PREDICTOR OF OUTCOME IN SEPSIS
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Keywords
Critical Care, Infectious Diseases, Mortality, Ventilator Support, Inotropic Support, Shock Index, Sepsis.
Abstract
BACKGROUND: Sepsis screening tools are designed to promote early identification of sepsis. There is wide variation in diagnostic accuracy of these tools in predicting outcome. Clinical tools used for sepsis screening are SIRS criteria, vital signs, qSOFA, SOFA, NEWS and MEWS score. Most of these rely on laboratory information to define treatment strategies causing delays in care. The shock index is a bedside assessment defined as heart rate divided by SBP. Early phase of sepsis demonstrates physiological compensatory mechanism, keeping blood pressure from falling despite presence of decreased circulating blood volume by increasing heart rate. In such events, Shock Index (SI) is useful as an early warning.
AIM OF THE STUDY: To study the disease spectrum of patients with suspected sepsis and assess the usefulness of Shock Index (SI) in predicting the clinical outcome.
METHODS: 75 patients diagnosed with sepsis according to q SOFA Score were included for the study. Vital signs of study participants at the time of admission were used for calculating the SI and qSOFA scores. Blood investigations such as complete blood counts, lactate, creatinine, bilirubin levels, serum electrolytes and ABG analysis were used for calculating the initial SOFA score. Receiver Operating Curve (ROC) comparing SI, SOFA, qSOFA and lactate levels in terms of outcomes such as mortality, inotropic support requirement, ventilatory support and duration of hospital stay of patients was obtained.
RESULTS : Our study showed Shock index is a good predictor of mortality in Sepsis patients after SOFA score. We also found that Shock Index is a better predictor of need for inotropic support in Sepsis patients and is the second best predictor of need for ventilatory support after SOFA score in Sepsis.
CONCLUSION: The urinary tract and lungs are major sites of Sepsis. Shock Index performed as a good indicator of In-Hospital mortality, and its performance was comparable to other established indices like qSOFA score, SOFA score and Lactate levels. Shock index ≥1 was associated with greater rates of inotropic and ventilatory support requirement and longer duration of hospital stay.
CATEGORIES: Emergency Medicine, Internal Medicine, Infectious Disease.
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T. C. Nagesh Kumar
Associate Professor, Department of General Medicine, Ramaiah University of Applied Sciences, Bengaluru, India
Rahul H. Gowda
Junior Resident, Department of General Medicine, Ramaiah University of Applied Sciences, Bengaluru, India
Aadithya Shyllesh H
Junior Resident, Department of General Medicine, Ramaiah University of Applied Sciences, Bengaluru, India
Karthik K. Shetty
Junior Resident, Department of General Medicine, Ramaiah University of Applied Sciences, Bengaluru, India