Assessment of the shock index in septic shock: A systematic review

To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions.

Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs.

Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded.

Studies reporting measurement of the shock index or its modified variants.

Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study.

Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality.

The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.