Shock Index Predicts Mortality in Children with Severe Sepsis and Septic Shock
Keywords:
children, severe sepsis, septic shock, shock indexAbstract
Background and Objective: The shock index (SI) is a ratio of heart rate (HR) to systolic blood pressure (SBP) per minute. It has been found to be correlated with mortality in pediatric severe sepsis and septic shock. This study aimed to investigate whether the persistent abnormal SI at 6 hours after diagnosis (SI6) was associated with mortality.
Methods: This retrospective cohort study involved pediatric patients aged 1 month to 15 years admitted to the Pediatric Intensive Care Unit (PICU) with severe sepsis and septic shock. The SI was assessed at the time of diagnosis (SI0). Patients with normal SI0 were excluded, while those with abnormal SI0 were included and assessed for the SI at 6 hours after diagnosis (SI6). Subsequently, they were classified into the group with resolution of abnormal SI (normal SI6) and the group with persistent abnormal SI (abnormal SI6) at 6 hours, based on age-specific shock index cut-offs. Mortality at 48 hours was the primary outcome, while in-hospital mortality was the secondary outcome. The age-specific shock index cut-offs at the time of diagnosis indicate a SI greater than or equal to 1.98, 1.50, and 1.25 in children aged under 1, 1-6, and 6-15 years, respectively. Similarly, age-specific shock index cut-offs at 6 hours after diagnosis represent a SI greater than or equal to 1.66, 1.36, and 1.30 in children aged under 1, 1-6, and 6-15 years, respectively.
Results: All 60 patients with severe sepsis and septic shock were enrolled and assessed for the SI at the time of diagnosis (SI0). Subsequently, 44 patients with abnormal SI0 were assessed for the SI at 6 hours after diagnosis (SI6). There were 21 patients in the group with resolution of abnormal SI (normal SI6) and demonstrated a significantly decreased risk of in-hospital mortality compared to the group with persistent abnormal SI (abnormal SI6) at 6 hours (OR 0.07, 95% CI 0.01-0.36, p<0.001). However, there was no significant difference in mortality at 48 hours between the two groups. Furthermore, factors such as immunocompromise (AOR 23.88, 95% CI 1.32-431.31, p=0.032), nosocomial infection (AOR 45.21, 95% CI 2.28-898.55, p=0.012), and persistent abnormal SI at 6 hours after diagnosis (SI6) (AOR 86.59, 95% CI 3.01-2491.98, p=0.009) were found to be associated with an increased risk of in-hospital mortality.
Conclusion: A persistent abnormal SI at 6 hours after diagnosis (SI6) was significantly associated with increased in-hospital mortality, indicating potential inadequate hemodynamic resuscitation and the need for additional stabilization.
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