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Prognostic value of shock index in children with septic shock
Jeremie Rousseaux1, Bruno Grandbastien, Aimée Dorkenoo
1From the *Pediatric Intensive Care Unit, Jeanne-de-Flandre Hospital; †Department of Epidemiology and Public Health, Calmette Hospital, CHU de Lille; and ‡Univ Lille Nord de France, UDSL-EA 2694, Lille, France.
Insights
The shock index (SI) can predict mortality in children with septic shock. This easily calculated measure of hemodynamic instability may improve early recognition of severe sepsis.
Area of Science:
- Pediatric critical care medicine
- Hemodynamics
- Septic shock management
Background:
- Septic shock in children carries high mortality and morbidity.
- Early recognition of severe sepsis is crucial for improving outcomes.
- The shock index (SI), a ratio of heart rate (HR) to systolic blood pressure (SBP), is a potential noninvasive marker of hemodynamic instability but is understudied in pediatric populations.
Purpose of the Study:
- To investigate the utility of the SI as an early prognostic indicator in pediatric septic shock.
- To determine if SI can predict mortality in children with septic shock.
Main Methods:
- Retrospective study conducted in a pediatric intensive care unit.
- Collected HR, SBP, and lactate concentrations at multiple time points (0, 1, 2, 4, 6 hours) post-admission.
- Compared SI values between patients who survived and those who died.
Main Results:
- Shock index differed significantly between survivors and non-survivors at 0, 4, and 6 hours post-admission.
- Age-adjusted SIs at 0 and 6 hours were associated with increased risk of death.
- An abnormal SI at admission and 6 hours predicted mortality with a relative risk of 1.36.
Conclusions:
- The SI is a clinically relevant and easily calculable predictor of mortality in children with septic shock.
- SI may offer a superior assessment of hemodynamic status compared to HR and SBP alone.
- Utilizing SI can facilitate earlier identification of severe sepsis in pediatric patients.
Objectives:
Septic shock is frequent in children and is associated with high mortality and morbidity rates. Early recognition of severe sepsis improve outcome. Shock index (SI), ratio of heart rate (HR) and systolic blood pressure (SBP), may be a good noninvasive measure of hemodynamic instability that has been poorly studied in children. The aim of the study was to explore the usefulness of SI as an early index of prognosis for septic shock in children.
Methods:
The study was retrospective and performed in 1 pediatric intensive care unit at a university hospital. The following specific data were collected at 0, 1, 2, 4, and 6 hours after admission: HR and SBP for SI calculation and lactate concentration. Patients were divided into 2 groups according to their outcome (death/survival).
Results:
A total of 146 children admitted with septic shock between January 2000 and April 2010 were included. Shock index was significantly different between survivors and nonsurvivors at 0, 4, and 6 hours after admission (P = 0.02, P = 0.03, and P = 0.008, respectively). Age-adjusted SIs were different between survivors and nonsurvivors at 0 and 6 hours, with a relative risk of death at these time points of 1.85 (1.04-3.26) (P = 0.03) and 2.17 (1.18-3.96) (P = 0.01), respectively. Moreover, an abnormal SI both at admission and at 6 hours was predictive of death with relative risk of 1.36 (1.05-1.76).
Conclusions:
In our population of children with septic shock, SI was a clinically relevant and easily calculated predictor of mortality. It could be a better measure of hemodynamic status than HR and SBP alone, allowing for the early recognition of severe sepsis.
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