The shock index as a predictor of vasopressor use in emergency department patients with severe sepsis.
BACKGROUND
Severe sepsis is a leading cause of non-coronary death in hospitals across the United States. Early identification and risk stratification in the emergency department (ED) is difficult because there is limited ability to predict escalation of care. In this study we evaluated if a sustained shock index (SI) elevation in the ED was a predictor of short-term cardiovascular collapse, defined as vasopressor dependence within 72 hours of initial presentation.


METHODS
Retrospective dual-centered cross-sectional study using patients identified in the Yale-New Haven Hospital Emergency Medicine sepsis registry.


RESULTS
We included 295 patients in the study with 47.5% (n=140) having a sustained SI elevation in the ED. Among patients with a sustained SI elevation, 38.6% (54 of 140) required vasopressors within 72 hours of ED admission contrasted to 11.6% (18 of 155) without a sustained SI elevation (p=0.0001; multivariate modeling OR 4.42 with 95% confidence intervals 2.28-8.55) . In the SI elevation group the mean number of organ failures was 4.0 ± 2.1 contrasted to 3.2 ± 1.6 in the non-SI elevation group (p=0.0001).


CONCLUSIONS
ED patients with severe sepsis and a sustained SI elevation appear to have higher rates of short-term vasopressor use, and a greater number of organ failures contrasted to patients without a sustained SI elevation. An elevated SI may be a useful modality to identify patients with severe sepsis at risk for disease escalation and cardiovascular collapse.
Yale University, Department of Emergency Medicine, New Haven, Connecticut.
Charles R
CR
Wira
Yale University, Department of Emergency Medicine, New Haven, Connecticut.
Melissa W
MW
Francis
Stanford/Kaiser Emergency Medicine Program, Palo Alto, California.
Sundeep
S
Bhat
Yale University, Department of Emergency Medicine, New Haven, Connecticut.
Robert
R
Ehrman
Yale University, Department of Emergency Medicine, New Haven, Connecticut.
David
D
Conner
Yale University, Section of Pulmonary and Critical Care Medicine, New Haven, Connecticut.
Mark
M
Siegel
D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy*; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents