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Comparison of 4 Different Threshold Values of Shock Index in Predicting Mortality of COVID-19 Patients
1Specialist of Emergency Medicine, Department of Emergency Medicine, Kartal Dr. Lütfi Kırdar Şehir Hastanesi, Istanbul, Turkey.
Insights
The prehospital shock index (SI) can predict intensive care unit (ICU) needs and mortality in COVID-19 patients. A shock index of 0.9 or higher indicates a higher risk for severe outcomes.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) poses a significant global health challenge.
- Effective early triage of COVID-19 patients is crucial for optimizing healthcare resource allocation.
- Prehospital assessment tools are needed to identify high-risk patients early.
Purpose of the Study:
- To evaluate the accuracy of the prehospital shock index (SI) in predicting intensive care unit (ICU) admission.
- To assess the SI's ability to predict 30-day mortality in ambulance-transported COVID-19 patients.
- To determine the optimal SI threshold for predicting adverse outcomes in COVID-19.
Main Methods:
- A cohort of 364 adult patients with suspected or confirmed COVID-19 transported by ambulance was analyzed.
- The predictive performance of four shock index (SI) cutoff points (0.7, 0.8, 0.9, 1.0) was compared.
- Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used to evaluate discriminatory accuracy for mortality and ICU admission.
Main Results:
- The area under the curve (AUC) for predicting 30-day mortality was highest with an SI of 0.9 (AUC = 0.755).
- Patients with a prehospital SI greater than 0.9 were more likely to require ICU admission.
- A higher prehospital SI ( > 0.9) was associated with an increased mortality rate.
Conclusions:
- The prehospital shock index (SI) is a valuable tool for predicting prognosis in COVID-19 patients.
- An SI threshold of 0.9 demonstrated the best predictive performance for mortality and ICU requirements.
- Utilizing the SI in prehospital settings can aid in early risk stratification and resource management for COVID-19 patients.
Objective:
The object of this study was to examine the accuracy in prehospital shock index (SI) for predicting intensive care unit (ICU) requirement and 30-d mortality among from coronavirus disease 2019 (COVID-19) patients transported to the hospital by ambulance.
Methods:
All consecutive patients who were the age ≥18 y, transported to the emergency department (ED) by ambulance with a suspected or confirmed COVID-19 in the prehospital frame were included in the study. Four different cutoff points were compared (0.7, 0.8, 0.9, and 1.0) to examine the predictive performance of both the mortality and ICU requirement of the SI. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate each cut-off value discriminatory for predicting 30-d mortality and ICU admission.
Results:
The total of 364 patients was included in this study. The median age in the study population was 69 y (range, 55-80 y), of which 196 were men and 168 were women. AUC values for 30-d mortality outcome were calculated as 0.672, 0.674, 0.755, and 0.626, respectively, for threshold values of 0.7, 0.8, 0.9 and 1.0. ICU admission was more likely for the patients with prehospital SI > 0.9. Similarly, the mortality rate was higher in patients with prehospital SI > 0.9.
Conclusions:
Early triage of COVID-19 patients will ensure efficient use of health-care resources. The SI could be a helpful, fast, and powerful tool for predicting mortality status and ICU requirements of adult COVID-19 patients. It was concluded that the most useful threshold value for the shock index in predicting the prognosis of COVID-19 patients is 0.9.
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