Diagnostic Accuracy of Triage Shock Index in Predicting Hyperlactatemia in Patients With Sepsis in the Emergency...

Sepsis is a condition if detected early, can substantially reduce morbidity and mortality. This condition is often diagnosed late, increasing the clinical and logistical challenges in the emergency department. Shock index (SI), defined as the ratio of systolic blood pressure (SBP) to heart rate (HR), has proven advantageous for detecting hemodynamic compromise early. The primary outcome of the study aims to determine the diagnostic accuracy of triage SI in predicting hyperlactatemia (>36 mg/dL) in patients with sepsis presenting to the emergency department. The objective was to determine the diagnostic accuracy of triage SI in predicting hyperlactatemia (lactate ≥36 mg/dL) in adult ED patients diagnosed with sepsis, using ROC analysis.

This was a prospective cross-sectional study conducted in a tertiary care center in South India from August 2016 to July 2018. Adult patients presenting to the emergency department with suspected infection were screened for sepsis. The triage, vital signs, and basic laboratory tests, including initial serum lactate levels, were measured. Analysis included calculation of sensitivities, specificities, and positive and negative predictive values for the primary outcome.

The analysis of 150 patients in our study revealed good sensitivity (81.6%) and negative predictive value (89.2%) for triage SI in predicting hyperlactatemia in sepsis. However, lower specificity (51.8%) and positive predictive value (36.5%) suggest limitations in precisely confirming these outcomes.

The study concluded that SI greater than 0.68 is a sensitive bedside tool in the early prediction of hyperlactemia in patients with sepsis, and it can be used with other vital signs for effectively triaging patients for giving prompt ED care. Further multi-center studies are required to assess for further validation to incorporate into clinical practice.