Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Selection Criteria
2.2. Search Strategy
2.3. Study Selection
2.4. Data Extraction
2.5. Quality Assessment
2.6. Data Analysis
3. Results
3.1. Search Results
3.2. Quality Assessment
3.3. Characteristics of Studies Included
3.3.1. Sepsis
3.3.2. Community-Acquired Pneumonia
3.4. Shock Index in Patients with Sepsis
3.4.1. Shock Index as a Predictor of Mortality in Patients with Sepsis
3.4.2. Shock Index as a Predictor of Morbidity in Sepsis
3.4.3. Modifications of Shock Index in Patients with Sepsis
3.5. Shock Index in Patients with CAP
3.5.1. Shock Index and Adjusted Shock Index as a Predictor of Mortality and Morbidity in Patients with CAP
3.5.2. Modifications of Shock Index and Adjusted Shock Index in Patients with CAP
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Conflicts of Interest
References
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Author/Year | Design | n | Location | Setting | Study Population | Mortality (%) | Admitted to ICU (%) | Index Test and Range | Outcome(s) of Interest |
---|---|---|---|---|---|---|---|---|---|
Sepsis studies | |||||||||
Baez et al., 2013 [23] | Retrospective cohort | 63 | USA; 1 centre | Pre-hospital | Adults (≥ 18) with ICD-9 diagnostic code of sepsis, severe sepsis or septic shock | 34.9 | 68.3 | SI ≥ 0.7 | In-hospital mortality ICU admission |
Berger et al., 2013 [31] | Retrospective cohort | 2524 | USA; 1 centre | ED | Adults (≥ 21) screened for sepsis using standardised blood order | 13.5 | - | SI ≥ 0.7; SI ≥ 1 | 28-day mortality |
Chung et al., 2019 [25] | Retrospective cohort | 409 | Taiwan; 1 centre | ED | Elderly patients (≥ 65) with pyrexia confirmed influenza | 4.9 | - | SI ≥ 1.0 | 30-day mortality |
Jaimes et al., 2005 [32] | Prospective cohort | 533 | Colombia; 2 centres | ED | Adults (≥ 16) suspected sepsis (2012 definition) | 18.9 | 14.1 | SI; full range | Multivariable modelling to predict 28-day mortality |
Jayarakash et al., 2018 [24] | Retrospective cohort | 578 | USA; 1 centre | Medical ICU | Adults (≥ 18) admitted to ICU with severe sepsis or septic shock (2012 definition) | 19.9 | 100 | MSI ≥ 1.3 | In-hospital mortality |
Lombaard et al., 2015 [26] | Audit | 47 | South Africa; 1 centre | Maternity ward | Adult patients with septic incomplete abortion | 19.2 | - | SI ≥ 1.0 | In-hospital mortality |
Talmor et al., 2007 [33] | Prospective cohort | 3260 | Israel; 1 centre | ED | Adults (≥ 18) who had blood cultures taken | 4.7 | 12 | SI ≥ 1.0 | In-hospital mortality or ICU |
Wira et al., 2014 [27] | Retrospective cohort | 295 | USA; 1 centre | ED | Adults (≥ 18) with severe sepsis (2012 definition) | 15.6 | - | SI ≥ 0.8 for ≥ 80% of ED values | Vasopressor dependence by 72-h 28-day mortality |
Yussof et al., 2012 [28] | Retrospective cohort | 50 | Malaysia; 1 centre | ED | Adults (≥ 18) triaged to resuscitation area with sepsis or septic shock (2012 definition) | 54% | - | SI; entire range at presentation and 2 h | In-hospital mortality |
Community-acquired pneumonia (CAP) studies | |||||||||
Curtain et al., 2013 [19] | Prospective cohort | 95 | UK; 1 centre | Hospital ward | Adults (≥ 18) admitted with CAP (symptoms and new CXR shadow) | 8.4% | 9.5% | SI and ASI ≥ 1.0, as part of CURSI, CURASI score | 6-week mortality |
Eldaboosy et al., 2015 [20] | Retrospective cohort | 100 | Egypt and Saudi Arabia; 2 centres | Hospital ward | Adults admitted with CAP (symptoms and new CXR shadow) | 9% | 34% | SI ≥ 0.7, as part of SIPF score | In-hospital mortality ICU admission |
Musonda et al., 2011 [17] | Prospective cohort | 190 | UK; 3 centres | AMAU | Adults (≥ 18) admitted with CAP (symptoms and new CXR shadow) | 28.4% | - | SI ≥ 1.0, as part of CARSI and CARASI score | 42-day mortality |
Myint et al., 2010 [30] | Prospective cohort | 190 | UK; 3 centres | AMAU | Adults (≥ 18) admitted with CAP (symptoms and new CXR shadow) | 28.4% | - | SI ≥ 1.0, as part of CURSI and CURASI score | 42-day mortality |
Nullmann et al., 2014 [21] | Retrospective cohort | 553 | Germany; 1 centre | Hospital ward | Adults (≥ 18) admitted with CAP (symptoms and new CXR shadow) | 10.7% | 10.5% | SI ≥ 1.0, as part of CURSI score | 30-day mortality |
Sankaran 2011 [29] | Prospective cohort | 190 | UK; 3 centres | AMAU | Adults (≥ 18) admitted with CAP (symptoms and new CXR shadow) | 28.4% | - | SI ≥ 1.0 ASI ≥ 1.0 | 42-day mortality |
Author/Year | n | SI Threshold | Mortality (%) | Test Characteristics for Prediction of Mortality | ||||
---|---|---|---|---|---|---|---|---|
Sens | Spec | PPV | NPV | OR | ||||
Baez et al., 2013 [23] | 63 | SI ≥ 0.7 | 34.9 | - | - | - | - | 1.66 (0.59–4.65) |
Berger et al., 2013 [31] | 2524 | SI ≥ 0.7 | 13.5 | 0.71 (0.66–0.76) | 0.41 (0.39–0.43) | 0.17 (0.16–0.18) | 0.89 (0.88–0.91) | 1.68 (1.32–2.14) |
- | SI ≥ 1.0 | - | 0.32 (0.27–0.36) | 0.79 (0.77–0.81) | 0.23 (0.20–0.26) | 0.85 (0.84–0.86) | 2.24 (1.81–2.91)) | |
Chung et al., 2019 [25] | 409 | SI ≥ 1.0 | 4.9 | 0.30 (0.12–0.54) | 0.94 (0.91–0.96) | 0.21 (0.11–0.36) | 0.96 (0.95–0.97) | 6.78 (2.39–19.29) |
Lombbard et al., 2015 [26] | 47 | SI ≥ 1.0 | 19.2 | 0.77 (0.40–0.97) | 0.29 (0.15–0.46) | 0.21 (0.15–0.28) | 0.85 (0.25–0.54) | 1.43 (0.26–7.97) |
Talmor et al., 2007 [33] | 3260 | SI ≥ 1.0 | 4.7 | - | - | - | - | 2.8 (1.8–4.2) |
Wira et al., 2014 [27] | 295 | SI ≥ 0.8 for > 80% of ED measurements | 15.6 | 0.59 (0.43–0.73) | 0.55 (0.48–0.61) | 0.19 (0.15–0.24) | 0.88 (0.83–0.91) | 1.71 (0.90–3.23) |
Yussof et al., 2012 [28] | 50 | SI ≥ 1.2 on admission | 54 | 0.73 | 0.45 | - | - | - |
- | SI ≥ 1.0 at 2 h | - | 0.81 | 0.79 | - | - | - |
Author/Year | n | SI Threshold | Mortality (%) | Test Characteristics for Prediction of Mortality | ||||
---|---|---|---|---|---|---|---|---|
Sensitivity | Specificity | PPV | NPV | OR | ||||
Nullmann et al., 2014 [21] | 443 | SI ≥ 1.0 | 10.7 | 0.25 (0.15–0.38) | 0.87 (0.84–0.90) | 0.18 (0.12–0.26) | 0.92 (0.90–0.92) | 2.72 (1.42–5.21) |
Sankaran 2011 [29] | 190 | SI ≥ 1.0 | 28.4 | 0.28 (0.16–0.41) | 0.83 (0.75–0.89) | 0.39 (0.27–0.54) | 0.74 (0.71–0.78) | 1.89 (0.90–3.98) |
- | ASI ≥ 1.0 | - | 0.22 (0.12–0.36) | 0.90 (0.83–0.94) | 0.45 (0.30–0.63) | 0.74 (0.71–0.77) | 2.49 (1.07–5.81) |
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Middleton, D.J.; Smith, T.O.; Bedford, R.; Neilly, M.; Myint, P.K. Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review. J. Clin. Med. 2019, 8, 1144. https://doi.org/10.3390/jcm8081144
Middleton DJ, Smith TO, Bedford R, Neilly M, Myint PK. Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review. Journal of Clinical Medicine. 2019; 8(8):1144. https://doi.org/10.3390/jcm8081144
Chicago/Turabian StyleMiddleton, David J., Toby O. Smith, Rachel Bedford, Mark Neilly, and Phyo Kyaw Myint. 2019. "Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review" Journal of Clinical Medicine 8, no. 8: 1144. https://doi.org/10.3390/jcm8081144