Prognostic value of shock index in children with septic shock.
OBJECTIVE
Septic shock is frequent in children and is associated with high mortality and morbidity rates. Early recognition of severe sepsis improve outcome. Shock index (SI), ratio of heart rate (HR) and systolic blood pressure (SBP), may be a good noninvasive measure of hemodynamic instability that has been poorly studied in children. The aim of the study was to explore the usefulness of SI as an early index of prognosis for septic shock in children.


METHODS
The study was retrospective and performed in 1 pediatric intensive care unit at a university hospital. The following specific data were collected at 0, 1, 2, 4, and 6 hours after admission: HR and SBP for SI calculation and lactate concentration. Patients were divided into 2 groups according to their outcome (death/survival).


RESULTS
A total of 146 children admitted with septic shock between January 2000 and April 2010 were included. Shock index was significantly different between survivors and nonsurvivors at 0, 4, and 6 hours after admission (P = 0.02, P = 0.03, and P = 0.008, respectively). Age-adjusted SIs were different between survivors and nonsurvivors at 0 and 6 hours, with a relative risk of death at these time points of 1.85 (1.04-3.26) (P = 0.03) and 2.17 (1.18-3.96) (P = 0.01), respectively. Moreover, an abnormal SI both at admission and at 6 hours was predictive of death with relative risk of 1.36 (1.05-1.76).


CONCLUSIONS
In our population of children with septic shock, SI was a clinically relevant and easily calculated predictor of mortality. It could be a better measure of hemodynamic status than HR and SBP alone, allowing for the early recognition of severe sepsis.
From the *Pediatric Intensive Care Unit, Jeanne-de-Flandre Hospital; †Department of Epidemiology and Public Health, Calmette Hospital, CHU de Lille; and ‡Univ Lille Nord de France, UDSL-EA 2694, Lille, France.
Jeremie
J
Rousseaux
Bruno
B
Grandbastien
Aimée
A
Dorkenoo
Marie Emilie
ME
Lampin
Stéphane
S
Leteurtre
Francis
F
Leclerc
D000367:Age Factors; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006339:Heart Rate; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007773:Lactates / Q000097:blood; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis
D007773:Lactates