Prediction Of Outcome In Patients With Severe Sepsis And Septic Shock Using Shock Index And Other Parameters-A One Year Hospital Based Observational Study

Abstract

Background and Objectives Shock Index is a simple bedside measurement tool that can predict prognosis in patients admitted to the emergency department. The present study was aimed to evaluate the value of shock index in prognosticating short-term outcome for patients with severe sepsis and septic shock at admission and after half an hour of initial resuscitation. Methodology The present one year hospital based observational study was done in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. A total of 100 patients admitted with severe sepsis or septic shock in the Emergency Department from January 2014 to December 2014 were studied. Shock Index, calculated as heart rate divided by the systolic blood pressure was assessed at admission and after half an hour of initial resuscitation in emergency department. Results Of the 100 patients studied, 62% of the patients had severe sepsis and 38% had septic shock. Most of the patients were males (62%) and the male to female ratio was 1.63:1. The commonest age group was 41 to 50 years (21%) and the mean age was 49.8 ± 16.5 years. Shock index of > 0.7 was noted in majority of the patients at admission (99%) and at 30 minutes after admission (94%). Mortality was noted in 62% of the patients. Significantly higher mortality was noted in patients with a higher shock index at 30 minutes after admission (p<0.001). The mean shock index at 30 minutes after admission was significantly higher in patients who expired (p<0.001). Using a cut-off value of shock index as 1.15 (AUC=0.949; p<0.001) after initial resuscitation of 30 minutes from admission, yielded higher accuracy in predicting mortality (sensitivity 87.1% and specificity 92.11%). Conclusion and Interpretation Shock index not only helps in risk stratification of patients with septic shock and severe sepsis but helps in prognosticating mortality when evaluated after initial resuscitation of 30 minutes.