Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.
Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
Am J Emerg Med. 2019 Mar;37(3):391-394. doi: 10.1016/j.ajem.2018.05.059. Epub 2018 May 29.
The shock index is a rapid and simple tool used to predict mortality in patients with acute illnesses including sepsis, multiple trauma, and postpartum hemorrhage. However, its ability to predict mortality in geriatric patients with influenza in the emergency department (ED) remains unclear. This study was conducted to clarify this issue.
We conducted a retrospective case-control study, recruiting geriatric patients (≥ 65 years) with influenza visiting the ED of a medical center between January 01, 2010 and December 31, 2015. Demographic data, vital signs, shock index, past histories, subtypes of influenza, and outcomes were included for the analysis. We investigated the association between shock index ≥1 and 30-day mortality.
In total, 409 geriatric ED patients with mean age of 79.5 years and nearly equal sex ratio were recruited. The mean shock index ± standard deviation was 0.7 ± 0.22 and shock index ≥1 was accounted for in 7.1% of the total patients. Logistic regression showed that shock index ≥1 predicted mortality (odds ratio: 6.80; 95% confidence interval: 2.39-19.39). The area under the receiver operating characteristic was 0.62 and the result of the Hosmer-Lemeshow goodness-of-fit test was 0.23. The sensitivity, specificity, positive predictive value, and negative predictive value of a shock index ≥1 were 30.0%, 94.1%, 20.0%, and 96.4%.
A shock index ≥1 has a high specificity, negative predictive value, and good reliability to predict 30-day mortality in geriatric ED patients with influenza.
休克指数是一种快速而简单的工具，用于预测包括脓毒症、多发创伤和产后出血在内的急性疾病患者的死亡率。然而，其在急诊科（ED）患有流感的老年患者中预测死亡率的能力尚不清楚。本研究旨在阐明这一问题。
我们进行了一项回顾性病例对照研究，招募了 2010 年 1 月 1 日至 2015 年 12 月 31 日期间在一家医学中心的 ED 就诊的患有流感的老年患者（≥65 岁）。纳入了人口统计学数据、生命体征、休克指数、既往病史、流感亚型和结局进行分析。我们调查了休克指数≥1 与 30 天死亡率之间的关联。
共纳入了 409 名平均年龄为 79.5 岁且性别比例几乎相等的老年 ED 患者。平均休克指数±标准差为 0.7±0.22，休克指数≥1 的患者占总患者的 7.1%。Logistic 回归显示，休克指数≥1 预测死亡率（优势比：6.80；95%置信区间：2.39-19.39）。接受者操作特征曲线下的面积为 0.62，Hosmer-Lemeshow 拟合优度检验的结果为 0.23。休克指数≥1 的灵敏度、特异性、阳性预测值和阴性预测值分别为 30.0%、94.1%、20.0%和 96.4%。
休克指数≥1 对预测急诊科患有流感的老年患者 30 天死亡率具有高特异性、阴性预测值和良好的可靠性。
