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Published on: March 22, 2024
Prehospital shock index to assess 28-day mortality for septic shock
Romain Jouffroy1, Jean Pierre Tourtier2, Papa Gueye3
1Department of Anesthesia & Intensive Care Unit, SAMU, University Paris Descartes, Hôpital Necker - Enfants, Malades, 149 Rue de Sèvres, 75015 Paris, France; Department of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote, School of Medicine, Faculty of Health Sciences, McMaster University. Hamilton, Ontario, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research, Institute Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
Insights
Early identification of septic shock (SS) is crucial. A prehospital shock index (SI) greater than 0.9 is a simple tool that indicates increased mortality risk in patients with SS.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Early identification of septic shock (SS) and its mortality risk is essential for timely treatment and patient disposition.
- A need exists for prognostic measures to identify high-risk patients in prehospital settings.
Purpose of the Study:
- To describe the association between prehospital shock index (SI) and 28-day mortality in patients with SS.
- To evaluate the utility of SI as a prognostic tool in the prehospital setting.
Main Methods:
- Retrospective analysis of 114 patients with SS treated by a mobile intensive care unit (MICU) from January 2016 to May 2019.
- Propensity score matching was used to assess the association between SI and mortality.
- Odds Ratio (OR) with 95% confidence interval (CI) was calculated.
Main Results:
- The overall 28-day mortality rate was 33%.
- Median SI differed significantly between alive (0.73) and deceased (0.80) patients (p < 0.001).
- An SI > 0.9 was associated with increased mortality (OR = 1.17; 95% CI [1.03–1.32]) after adjusting for confounding factors.
Conclusions:
- Prehospital shock index (SI) is associated with mortality in patients with septic shock (SS).
- An SI > 0.9 serves as a readily available prognostic tool for increased mortality risk in prehospital SS patients.
Context:
In the prehospital setting, early identification of septic shock (SS) with high risk of mortality aims to initiate early treatments and to decide delivery unit (emergency department (ED) or intensive care unit (ICU)). In this context, there is a need for a prognostic measure of severity and death in order to early detect patients with a higher risk of pejorative evolution. In this study, we describe the association between prehospital shock index (SI) and mortality at day 28 of patients with SS initially cared for in the prehospital setting by a mobile intensive care unit (MICU).
Methods:
Patients with SS cared for by a MICU between January 2016 and May 2019 were retrospectively analyzed. Using propensity score, the association between SI and mortality was assessed by Odd Ratio (OR) with 95 percent confidence interval [95 CI].
Results:
One-hundred and fourteen patients among which 78 males (68%) were analysed. The mean age was 71 ± 14 years old. SS was mainly associated with pulmonary (55%), digestive (20%) or urinary (11%) infection. Overall mortality reached 33% (n = 38) at day 28. Median SI [interquartile range] differed between alive and deceased patients: 0.73 [0.61-1.00] vs 0.80 [0.66-1.10], p < 0.001*). After adjusting for confounding factors, the OR of SI > 0.9 was 1.17 [1.03-1.32].
Conclusion:
In this study, we report an association between prehospital SI and mortality of patients with prehospital SS. A SI > 0.9 is a readily available tool correlated with increased mortality of patients with SS initially cared for in the prehospital setting.
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