Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Abstract Background Although the shock index is known to predict mortality and other severe outcomes, deriving it requires complex calculations. Subtracting the systolic blood pressure from the heart rate may produce a simple shock index that would be a clinically useful substitute for the shock index. In this study, we investigated whether the simple shock index was equivalent to the shock index. Methods This observational cohort study was conducted at 2 tertiary care hospitals. Patients who were transported by ambulance were recruited for this study and were excluded if they were aged < 15 years, had experienced prehospital cardiopulmonary arrest, or had undergone inter-hospital transfer. Pearson’s product-moment correlation coefficient and regression equation were calculated, and two one-sided tests were performed to examine their equivalency. Results Among 5429 eligible patients, the correlation coefficient between the shock index and simple shock index was extremely high (0.917, 95% confidence interval 0.912 to 0.921, P < .001). The regression equation was estimated as sSI = 258.55 log SI. The two one-sided tests revealed a very strong equivalency between the shock index and the index estimated by the above equation using the simple shock index (mean difference was 0.004, 90% confidence interval 0.003 to 0.005). Conclusion The simple shock index strongly correlated with the shock index.

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Shock Index as Simple Clinical Independent Predictor of In-hospital MACEs in NSTEMI Patients Presenting with Heart Failure

Indonesian Journal of Cardiology ◽

10.30701/ijc.v38i2.731 ◽

2017 ◽

pp. 81-88

Author(s):

Ahmad Handayani ◽

Kartika Kaban ◽

Marwan Nasri ◽

Zulfikri Mukhtar ◽

Abdullah Afif Siregar

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Independent Predictor ◽

Shock Index ◽

Laboratory Examination ◽

Short Term ◽

St Elevation ◽

Grace Score

Background: Identification of Non-ST Elevation Myocardial Infarction (NSTEMI) patientsat higher risk of in-hospital complications is very important. Such identification will givecrucial information in determining treatment strategy especially for those come with heartfailure. One of the simple predictor for short term prognosis in acute coronary syndromeis shock index (SI), which is the ratio of heart rate over systolic blood pressure on admission.There had not been any study conducted to evaluate the use of SI in NSTEMI patientscome with heart failure. The aim of this study is to evaluate the SI compared with otherroutine clinical and laboratory examination as a predictor of in-hospital major adversecardiac events (MACEs) in NSTEMI patients presenting with heart failure.Methods: We performed a retrospective analysis of NSTEMI patients with heart failureadmitted to Haji Adam Malik General Hospital in Medan from January 2014 until July 2015.SI was calculated as the ratio of heart rate over systolic blood pressure on presentation.Patients presenting with cardiogenic shock were excluded.Results: There were 55 patients eligible in this study. In-hospital MACEs was found in 24patients (44%) compared with 31 patients (56%) without in-hospital MACEs. Patientswith in-hospital MACEs were older (60.6±10.8 vs. 57.2±7.9, p=0.178), had less historyof dyslipidemia [8(33%) vs. 19 (61%), p=0.032], faster heart rate (111.4±35.8 vs.96.5±24.3, p=0.032], higher GRACE score [139(98-187) vs. 120 (91-148); p=0.001],and higher SI [0.83(0.57-1.5) vs. 0.67 (0.38-1.27), p=0.013). SI >0.8 was the only independentpredictor of MACEs in NSTEMI patients presenting with heart failure (OR=4.3,CI=1.247-14.328, p=0.048).Conclusion: Beyond other routine examinations, SI is the only independent predictor ofin-hospital MACEs in NSTEMI patients presenting with heart failure.

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Equivalency between the shock index and subtracting the systolic blood pressure from the heart rate: An observational cohort study

10.21203/rs.3.rs-51296/v1 ◽

2020 ◽

Author(s):

Yohei Kamikawa ◽

Hiroyuki Hayashi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cohort Study ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Correlation Coefficient ◽

Observational Cohort Study ◽

Regression Equation ◽

Shock Index ◽

Observational Cohort

Abstract Background: Although the shock index is known to predict mortality and other severe outcomes, deriving it requires complex calculations. Subtracting the systolic blood pressure from the heart rate may produce a simple shock index that would be a clinically useful substitute for the shock index. In this study, we investigated whether the simple shock index was equivalent to the shock index.Methods: This observational cohort study was conducted at 2 tertiary care hospitals. Patients who were transported by ambulance were recruited for this study and were excluded if they were aged < 15 years, had experienced prehospital cardiopulmonary arrest, or had undergone inter-hospital transfer. Pearson’s product-moment correlation coefficient and regression equation were calculated, and two one-sided tests were performed to examine their equivalency.Results: Among 5,429 eligible patients, the correlation coefficient between the shock index and simple shock index was extremely high (0.917, 95% confidence interval 0.912 to 0.921, P < .001). The regression equation was estimated as sSI = 258.55 log SI. The two one-sided tests revealed a very strong equivalency between the shock index and the index estimated by the above equation using the simple shock index (mean difference was 0.004, 90% confidence interval 0.003 to 0.005).Conclusion: The simple shock index strongly correlated with the shock index.

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THE PREDICTIVE VALUE OF MODIFIED SHOCK INDEX FOR HOSPITAL MORTALITY

10.36106/ijar/2810704 ◽

2021 ◽

pp. 19-21

Author(s):

Praveenkumar Biradar ◽

Vijayakumara Vijayakumara ◽

Veeresh B ◽

Udaykumar Jaihind Khasage ◽

Kartik Katti

Keyword(s):

Blood Pressure ◽

Hospital Mortality ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Clinical Severity ◽

Age Group ◽

Shock Index ◽

Inclusion Criteria ◽

The Mean ◽

Lactate Levels

INTRODUCTION: Shock Index uses only systolic blood pressure; however, diastolic blood pressure is also of undeniable importance when determining patient's clinical severity. All METHODOLOGY: patients who t into the inclusion criteria were requested for consent to join the study. The patients were further divided into sub-groups as per their working diagnosis as medical or surgical cases and denitive diagnosis were noted. In the prese RESULTS: nt study, the mean age group for patients on whom lactate levels were done was found to be 53.2±15.9 years and the maximum study samples were in the age group 60-69. The mean of systolic blood pressure, diastolic blood pressure, heart rate, MAP, Shock Index, Modied Shock Index and lactate levels in our study was 104.1±26.8 mm/hg, 72.4±18.4 mm/hg, 116.9±18.7, 83.1±20.4 mm/hg, 1.2±0.5, 1.5±0.6 and 4.9±2.6 respectively. The p CONCLUSION: redictive value of MSI for hospital mortality was calculated by ROC curve where the sensitivity was 0.750 and specicity was 0.454.

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Outcome of Saddle Pulmonary Embolism: A Nested Case-Control Study.

Blood ◽

10.1182/blood.v116.21.1102.1102 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1102-1102

Author(s):

Gauruv Bose ◽

Esteban Gandara ◽

Marc Carrier ◽

Petra MG Erkens ◽

Marc Rodger ◽

...

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

Systolic Blood Pressure ◽

Conflicts Of Interest ◽

Management Strategies ◽

Pulmonary Arteries ◽

Pulmonary Angiography ◽

Control Group ◽

P Value ◽

Case Group

Abstract Abstract 1102 Introduction: The management of saddle pulmonary embolism (PE) is controversial. Evidence about outcomes and management strategies is scarce in the literature due to the small prevalence of saddle PE. Historically it has been recommended that this group of patients should be treated aggressively. Purpose: To determine the prevalence and outcomes of patients diagnosed with saddle PE. Methods: Retrospective cohort study of consecutive patients with saddle PE diagnosed at the Ottawa Hospital between January 2007 and December 2008. Patients were included if a thrombus was present on computed tomographic pulmonary angiography (CTPA) in the main pulmonary arteries spanning the bifurcation of the main pulmonary trunk. These cases were each matched with two non-saddle controls with proximal PE (thromboemboli in the main pulmonary arteries) based on age, sex, systolic blood pressure greater than or less than 90 mmHg, and the presence or absence of cancer. Demographics, prognostic factors, treatment, and outcomes were collected. Patients were followed over a 30 day period following the diagnosis. RESULTS: A total of 32 (5%) of 724 patients with PE had a saddle event. Baseline characteristics are depicted in Table 1. Differences between the saddle case group and non-saddle control group include the presence of right ventricular dilation (59% of saddle cases vs. 22% of controls, p-value: 0.0007) and in the proportion of patients managed as outpatients (7% of saddle cases vs. 33% of controls, p-value: 0.02). At 30 days no differences were found in patients with saddle PE or proximal PE for all cause mortality (6% vs. 10%; OR: 0.64; 95% CI: 0.08–3.2), PE related mortality (0% vs. 6%; OR: 0.52; 95% CI: 0.01–6.1), major bleeding (3% vs. 5%; OR: 0.65; 95% CI: 0.02–6.4), or recurrent venous thromboembolism (6% vs. 10%; OR: 0.64; 95% CI: 0.08–3.2). Conclusions: Patients with saddle PE do not have a worse 30-day prognosis than patients with proximal PE matched by age, sex, systolic blood pressure, and presence of cancer. Disclosures: No relevant conflicts of interest to declare.

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THE EFFECT OF TISSUE DAMAGE ON THE RESPONSE OF SYSTOLIC BLOOD PRESSURE (SBP), HEART RATE (HR), SHOCK INDEX (SI) AND TYMPANIC TEMPERATURE (TT) TO HAEMORRHAGE.

Shock ◽

10.1097/00024382-199409001-00080 ◽

1994 ◽

Vol 2 (Supplement) ◽

pp. 34

Author(s):

P Driscoll ◽

R Little

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Tissue Damage ◽

Tympanic Temperature ◽

Shock Index

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Substituting systolic blood pressure with shock index in the National Trauma Triage Protocol

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000001205 ◽

2016 ◽

Vol 81 (6) ◽

pp. 1136-1141 ◽

Cited By ~ 16

Author(s):

Ansab A. Haider ◽

Asad Azim ◽

Peter Rhee ◽

Narong Kulvatunyou ◽

Kareem Ibraheem ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Shock Index ◽

National Trauma ◽

Triage Protocol ◽

Trauma Triage

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The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

10.21203/rs.3.rs-33779/v2 ◽

2020 ◽

Author(s):

Se Jin Park ◽

Mi Jin Lee ◽

Changho Kim ◽

Haewon Jung ◽

Seong Hun Kim ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Logistic Regression ◽

Systolic Blood Pressure ◽

Massive Transfusion ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Shock Index ◽

Cutoff Value ◽

The Impact

Abstract Background: Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives. Methods: This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes. Results: We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives. Conclusions: The triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

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Systolic blood pressure and mortality in acute symptomatic pulmonary embolism

International Journal of Cardiology ◽

10.1016/j.ijcard.2019.11.102 ◽

2020 ◽

Vol 302 ◽

pp. 157-163

Author(s):

Andrés Quezada ◽

David Jiménez ◽

Behnood Bikdeli ◽

Lisa Moores ◽

Mateo Porres-Aguilar ◽

...

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

Systolic Blood Pressure ◽

Symptomatic Pulmonary Embolism

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PP27 Pre-hospital lactate monitoring: a worthy adjunct to systolic blood pressure and shock index in triggering blood product administration in patients with suspected traumatic haemorrhage?

Emergency Medicine Journal ◽

10.1136/emermed-2019-999.27 ◽

2019 ◽

Vol 36 (1) ◽

pp. e11.1-e11

Author(s):

JE Griggs ◽

RM Lyon ◽

M Sherriff ◽

J Leung ◽

G Wareham

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Systolic Blood Pressure ◽

Point Of Care ◽

Care Service ◽

Standard Operating Procedure ◽

Continuous Variable ◽

Physiological Parameters ◽

Shock Index ◽

Transfusion Therapy

IntroductionPre-hospital identification of patients with suspected occult traumatic haemorrhage is problematic. Physiological parameters and clinical gestalt are inadequate surrogates for ongoing haemorrhage. Lactate monitoring may hold stronger predictive clinical utility to identify patients with suspected traumatic haemorrhage above other physiological parameters.MethodsA single centre, service evaluation of pre-hospital lactate monitoring. A point of care test was introduced into a Helicopter Emergency Medical Service in the United Kingdom. Clinicians adhered to strict education and governance, supported by standard operating procedure. Systolic blood pressure (SBP) and shock index (SI) was measured in patients that received pre-hospital transfusion therapy. A predetermined ‘cut off’ value of lactate >2.5 mmol was acknowledged. In-hospital follow up established further transfusion therapy.ResultsWilcoxon rank sum compared pre-lactate (n=22) and post-lactate (n=6) groups. Monte Carlo permutations were used to obtain exact probabilities. No statistically significant differences were found between groups for: SBP, p=0.955; and, SI, p=0.401. Univariate logistic regression identified the odds ratio (OR) and confidence interval (CI) for each continuous variable as: SBP, 0.97 (CI 0.94 to 1.01); SI, 26.91 (CI 1.11 to 652.48) and lactate >2.5 mmol, 2.33 (CI 0.23 to 23.91). Multivariate logistic regression identified OR as: SBP, 0.99 (CI 0.95 to 1.04); SI, 22.98 (CI 0.56 to 946.44); and lactate >2.5 mmol, 3.05 (CI 0.14 to 65.86).ConclusionLactate monitoring has been successfully introduced into an enhanced care service. The Results confirm SBP is not predictive of further transfusion. The OR for SI shows greater predictive power. Limited by a small dataset, the Results are hypothesis-generating only.

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