Effects of growth trajectory of shock index within 24 h on the prognosis of patients with sepsis

Abstract

BackgroundSepsis is a serious disease with high clinical morbidity and mortality. Despite the tremendous advances in medicine and nursing, treatment of sepsis remains a huge challenge. Our purpose was to explore the effects of shock index (SI) trajectory changes on the prognosis of patients within 24 h after the diagnosis of sepsis.MethodsThis study was based on Medical Information Mart for Intensive Care IV (MIMIC- IV). The effects of SI on the prognosis of patients with sepsis were investigated using C-index and restricted cubic spline (RCS). The trajectory of SI in 24 h after sepsis diagnosis was classified by latent growth mixture modeling (LGMM). Cox proportional hazard model, double robust analysis, and subgroup analysis were conducted to investigate the influence of SI trajectory on in-hospital death and secondary outcomes.ResultsA total of 19,869 patients were eventually enrolled in this study. C-index showed that SI had a prognostic value independent of Sequential Organ Failure Assessment for patients with sepsis. Moreover, the results of RCS showed that SI was a prognostic risk factor. LGMM divided SI trajectory into seven classes, and patients with sepsis in different classes had notable differences in prognosis. Compared with the SI continuously at a low level of 0.6, the SI continued to be at a level higher than 1.0, and the patients in the class whose initial SI was at a high level of 1.2 and then declined had a worse prognosis. Furthermore, the trajectory of SI had a higher prognostic value than the initial SI.ConclusionBoth initial SI and trajectory of SI were found to be independent factors that affect the prognosis of patients with sepsis. Therefore, in clinical treatment, we should closely monitor the basic vital signs of patients and arrive at appropriate clinical decisions on basis of their change trajectory.

Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with sepsis-associated liver injury: a retrospective cohort study

“…Patients with SALI (SALI) admitted to the ICU of the Beth Israel Deaconess Medical Center in Boston between 2008 and 2019 were included. Because the data came from the public database and is de-identified, the Institutional Review Board of the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center allows exemption of patients from the requirement of informed consent [ 18 ]. The first author, Xiaona Yi, completed the training on “Data or Specimens Only Research” and was allowed to use the public data (ID: 52,390,976).…”

Association of blood glucose change with postoperative delirium after coronary artery bypass grafting in patients with diabetes mellitus: a study of the MIMIC-IV database

“…The latent growth mixture modeling (LGMM) was utilized to classify the 24-h trajectory of blood glucose in patients with DM undergoing CABG ( 20 ). To select the best number of potential categories, we built quadratic growth models containing one to five classes.…”

Cardiogenic shock trajectories: is the Society for Cardiovascular Angiography and Interventions definition the right one?

“…Finally, although serial assessment of SCAI shock stage has been shown to provide important prognostic data, there is no clear consensus as to how frequently shock stage should be reassessed, or how changes in stage should be used to guide intervention. Of note, it took on average 52 and 103 h, respectively, for patients presenting with Stage B or Stage C shock to reach their maximal stage [24], emphasizing the need for reassessment over a period of days, and the somewhat counterintuitive conclusion that patients who appear less sick have the potential to deteriorate more quickly [18 ▪▪ ,25].…”