Emergency Department, Aga Khan University Hospital, Karachi, Pakistan.
J Ayub Med Coll Abbottabad. 2020 Oct-Dec;32(4):465-469.
Early detection of sepsis in the emergency department is of prime importance and requires tools that are time and cost-effective. The Systemic Inflammatory Response Syndrome (SIRS) has been poorly associated with sepsis. Timothy et al in a retrospective analysis of Emergency Department (ED) visit stated estimate of SIRS at 17.8% accounting to an annual yield of 16.6 million adult visits with SIRS per year, among these only 26% accounted as an infectious aetiology of SIRS, trauma being 10% and other causes being rare. Shock index is found to be independently associated with 30-day mortality in a broad population of ED patients including sepsis. With limited health resources in a low to middle income country, focused utilization is important and so is the need for markers that are non-invasive, readily available, cost effective, and easy to interpret. Shock index can serve this purpose as a surrogate marker of disease severity in patients with severe sepsis and thus resulting in early detection of such patients.
This cross-sectional study was conducted from December 2014 to May 2015 at a tertiary care setup (Aga Khan University Hospital) in Karachi consisting of all septic patients received at the emergency department. Non-probability sampling technique was used. p-value <0.05 was taken as significant.
Out of 180 study participants 94 (52.22%) were males while 86 (47.78%) were females. The mean age was 57.48±18.8 years. Cohen's κ was used to determine an agreement between the Shock index and Lactate levels. Shock index with cut off value of > 0.7 was used and moderate to the strong agreement between the two was found with kappa κ = 0.786 which was statistically significant (p=<0.001). Sensitivity was found to be 0.99, specificity 0.75, NPV 0.98, PPV 0.87.
To conclude the shock index has some very favourable features, including availability, low cost, and direct relevance to sepsis in terms of its high validity. A high SI predicts elevated lactate levels in patients with sepsis.
在急诊科尽早发现脓毒症至关重要，这需要使用既省时又省钱的工具。全身炎症反应综合征（SIRS）与脓毒症的相关性较差。Timothy 等人在对急诊科就诊患者进行的回顾性分析中指出，SIRS 的估计发生率为 17.8%，这意味着每年有 1660 万成年患者因 SIRS 就诊，其中只有 26%被认为是 SIRS 的感染病因，10%为创伤，其他病因则较为少见。休克指数与广泛的急诊科患者（包括脓毒症患者）的 30 天死亡率独立相关。在中低收入国家，医疗资源有限，因此需要使用非侵入性、易于获取、经济实惠且易于解读的标志物，有针对性地利用这些资源非常重要。休克指数可以作为严重脓毒症患者疾病严重程度的替代标志物，从而有助于早期发现此类患者。
本横断面研究于 2014 年 12 月至 2015 年 5 月在卡拉奇的一家三级保健机构（阿迦汗大学医院）进行，纳入了所有在急诊科就诊的脓毒症患者。采用非概率抽样技术。p 值<0.05 被认为具有统计学意义。
在 180 名研究参与者中，94 名（52.22%）为男性，86 名（47.78%）为女性。平均年龄为 57.48±18.8 岁。使用 Cohen's κ 来确定休克指数和乳酸水平之间的一致性。使用休克指数截断值>0.7，并发现两者之间存在中度至高度一致，κ 值为 0.786，具有统计学意义（p<0.001）。灵敏度为 0.99，特异性为 0.75，NPV 为 0.98，PPV 为 0.87。
总的来说，休克指数具有一些非常有利的特征，包括可用性、低成本和与脓毒症的直接相关性，因为其具有较高的有效性。高 SI 预测脓毒症患者的乳酸水平升高。
