Middleton David J, Smith Toby O, Bedford Rachel, Neilly Mark, Myint Phyo Kyaw
Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, Scotland, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
J Clin Med. 2019 Jul 31;8(8):1144. doi: 10.3390/jcm8081144.
To improve outcomes for patients who present to hospital with suspected sepsis, it is necessary to accurately identify those at high risk of adverse outcomes as early and swiftly as possible. To assess the prognostic accuracy of shock index (heart rate divided by systolic blood pressure) and its modifications in patients with sepsis or community-acquired pneumonia.
An electronic search of MEDLINE, EMBASE, Allie and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Open Grey, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (WHO ITRP) was conducted from conception to 26th March 2019. Eligible studies were required to assess the prognostic accuracy of shock index or its modifications for outcomes of death or requirement for organ support either in sepsis or pneumonia. The methodological appraisal was carried out using the Downs and Black checklist. Evidence was synthesised using a narrative approach due to heterogeneity.
Of 759 records screened, 15 studies (8697 patients) were included in this review. Shock index ≥ 1 at time of hospital presentation was a moderately accurate predictor of mortality in patients with sepsis or community-acquired pneumonia, with high specificity and low sensitivity. Only one study reported outcomes related to organ support.
Elevated shock index at time of hospital presentation predicts mortality in sepsis with high specificity. Shock index may offer benefits over existing sepsis scoring systems due to its simplicity.
为改善疑似脓毒症患者的治疗效果，必须尽早且迅速地准确识别出那些具有不良预后高风险的患者。评估休克指数（心率除以收缩压）及其修正指标在脓毒症或社区获得性肺炎患者中的预后准确性。
从建库至2019年3月26日，对MEDLINE、EMBASE、Allie和补充医学数据库（AMED）、护理及相关健康文献累积索引（CINAHL）、Open Grey、ClinicalTrials.gov和世界卫生组织国际临床试验注册平台（WHO ITRP）进行电子检索。纳入的合格研究需评估休克指数或其修正指标对脓毒症或肺炎患者死亡或器官支持需求结局的预后准确性。使用唐斯和布莱克清单进行方法学评估。由于存在异质性，采用叙述性方法综合证据。
在筛选的759条记录中，本综述纳入了15项研究（8697例患者）。入院时休克指数≥1是脓毒症或社区获得性肺炎患者死亡率的中度准确预测指标，具有高特异性和低敏感性。仅有一项研究报告了与器官支持相关的结局。
入院时休克指数升高对脓毒症死亡率具有高特异性的预测作用。休克指数因其简单性可能比现有的脓毒症评分系统更具优势。
