Modified shock index and mortality rate of emergency patients

Liu, Ye-cheng; Liu, Jihai; Fang, Zhe; Shan, Guangliang; Xu, Jun; Qi, Zhihong; Zhu, Huadong; Wang, Zhong; Yu, Xuezhong

doi:10.5847/wjem.j.issn.1920-8642.2012.02.006

Cited by 124 publications

(103 citation statements)

References 5 publications

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“…Its predicting value for the outcome has been fully demonstrated in the patients with trauma [1][2][3][4]. Recently, some studies further showed that a new index, MSI, in the ED is a more valuable marker for predicting the mortality rate than SI alone in adult patients with trauma [14].…”

Section: Discussionmentioning

confidence: 98%

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Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Shangguan

et al. 2015

The American Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 98%

“…Some studies have found that MSI is a better predictor than SI for the outcome in adult patients with trauma [14,15]. However, the predictive value of MSI has not been evaluated in the patients with STEMI.…”

Section: Introductionmentioning

confidence: 98%

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Shangguan

et al. 2015

The American Journal of Emergency Medicine

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“…13 It has been studied in nonspecific shock, [14][15][16] trauma, [17][18][19][20][21][22][23] and sepsis. 14,24 The normal SI range is 0.5-0.7 for healthy adults, 14,25 and an SI of >0.9 has been associated with increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Shock index: an effective predictor of outcome in postpartum haemorrhage?

Nathan

Ayadi

Hezelgrave

et al. 2014

BJOG

137

144

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Objectives To compare the predictive value of the shock index (SI) with conventional vital signs in postpartum haemorrhage (PPH), and to establish 'alert' thresholds for use in low-resource settings.Design Retrospective cohort study.Setting UK tertiary centre.Population Women with PPH ≥1500 ml (n = 233).Methods Systolic blood pressure (BP), diastolic BP, mean arterial pressure, pulse pressure, heart rate (HR) and SI (HR/systolic BP) were measured within the first hour following PPH. Values measured at the time of highest SI were selected for analysis. The area under the receiver operating characteristic curve (AUROC) for each parameter, used to predict admission to an intensive care unit and other adverse outcomes, was calculated. Sensitivity, specificity and negative/positive predictive values determined thresholds of the best predictor.Main outcome measures Intensive care unit (ICU) admission, blood transfusion ≥4 iu, haemoglobin level <7 g/dl, and invasive surgical procedures.Results Shock index has the highest AUROC to predict ICU admissions (0.75 for SI [95% CI 0.63-0.87] compared with 0.64 [95% CI 0.44-0.83] for systolic BP). SI compared favourably for other outcomes: SI ≥0.9 had 100% sensitivity (95% CI 73.5-100) and 43.4% specificity (95% CI 36.8-50.3), and SI ≥1.7 had 25.0% sensitivity (95% CI 5.5-57.2) and 97.7% specificity 3), for predicting ICU admission.Conclusions Shock index compared favourably with conventional vital signs in predicting ICU admission and other outcomes in PPH, even after adjusting for confounding; SI <0.9 provides reassurance, whereas SI ≥1.7 indicates a need for urgent attention. In low-resource settings this simple parameter could improve outcomes. It was not possible to adjust for resuscitative measures administered following vital sign measurement that may have influenced the outcome.

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“…Given the limited resources and information available at triage, MSI can be a valuable tool in predicting disease severity. Studies results show that in patients with a high MSI, there is an increased probability of ICU admission and death.MSI is a more important clinical predictor than blood pressure and heart rate because high MSI indicates a hypodynamic state [11].…”

Section: Discussionmentioning

confidence: 99%

Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

2016

JCCR

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Submit Manuscript | http://medcraveonline.com 8]. The concept of shock index, defined as the ratio of heart rate and systolic blood pressure, first introduced by Allgower et al, in 1967 as a simple and effective means for gauging the degree of hypovolemia in hemorrhagic and infectious shock states [9]. Subsequently, experimental and clinical studies demonstrated that SI was inversely related to physiologic parameters, such as cardiac index, stroke volume, left ventricular stroke work, and mean arterial pressure [10].A new index, modified shock index (MSI), is created by as the ratio of HR and mean arterial pressure (MAP). He noticed that SI uses only systolic blood pressure, but diastolic blood pressure (DBP) is also of undeniable importance when determining patient's clinical severity. Hence he incorporated diastolic blood pressure and developed the modified shock index (MSI) [16]. Subjects and MethodsThis study was carried prospectively and included 216 patients who presented to CCU of Cardiology department, Zagazig university hospitals with acute STEMI who were treated with PPCI (from 1/2014 until 8/2016), with A time window for doing PPCI of 12 hours from onset of maximum chest pain. Extended time window to 18 hours from onset of maximum chest pain was used for patients presented with cardiogenic shock. We excluded the patients who, received fibrinolytic therapy, presented more than 12 hours from the onset of chest pain except for whom presented with cardiogenic shock, died at ER or before doing PPCI and presented by acute hemorrhage, acute hypovolemia, severe sepsis, severe trauma, or suspicion of pulmonary embolism.Patients who met the inclusion criteria were subjected to thorough history taking, Physical examination with special emphasis on both Blood pressure and pulse that were measured accurately in the supine position with >2 readings were taken with 1 min interval, and averaged. Admission SI was calculated for every patient that equals (admission HR/ admission SBP). Modified Admission SI was calculated for every patient that equals (admission HR/ mean admission BP, here MBP= [(DBPx2) +SBP]/3). The optimal cut-off values of SI, and MSI were based on optimizing the sum of sensitivity and specificity by receiver operating characteristic curve analysis, which predicted inhospital major adverse cardiovascular events.The patients were divided into 4 groups: The TIMI risk score was calculated for each patient using the variables obtained at admission according to the published criteria [5]. Killip's classification, Chest examination: with emphasis on detecting pulmonary edema or presence of pulmonary congestion, Cardiac examination: with emphasis on detecting murmurs Volume 7 Issue 4 -2016

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Modified shock index and mortality rate of emergency patients

Cited by 124 publications

References 5 publications

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Shock index: an effective predictor of outcome in postpartum haemorrhage?

Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

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