Department of Pediatrics, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, People's Republic of China.
Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Eur J Med Res. 2022 Nov 3;27(1):227. doi: 10.1186/s40001-022-00857-y.
Septic shock is associated with increased mortality. Predicting mortality, including early prediction for septic shock patients in intensive care units (ICUs), remains an important challenge.
We searched the Medical Information Mart for Intensive Care IV database. Odds ratios (ORs) with 95% confidence intervals (CIs) of the relationships between shock index (SI), modified SI (MSI), and diastolic SI (DSI) of patients with septic shock requiring vasopressors and 3-day/in-hospital mortality were calculated using logistic regression models. The time-course changes of these parameters were compared between survivors and non-survivors. The performance of the different parameters was described by the area under the receiver operating characteristic (ROC) curve (AUC) and compared with DeLong analysis.
A total of 1266 patients with septic shock requiring vasopressors were identified. The 3-day mortality rate and in-hospital mortality rate were 8.7% and 23.5%, respectively. Multivariable logistic regression analysis showed significant associations between pre-vasopressor SI/MSI/DSI and 3-day mortality in patients with septic shock requiring vasopressors in fully adjusted models (Ps for trend < 0.01). The AUCs of pre-vasopressor SI, MSI, and DSI were 0.746, 0.710, and 0.732 for 3-day mortality, respectively. There were significant differences in the time-course of SI, MSI, and DSI between survivors and non-survivors at 3-day/in-hospital mortality among patients with septic shock requiring vasopressors (repeated-measures ANOVA, inter-subjects difference P < 0.001).
Pre-vasopressor SI, MSI, and DSI values identified patients with septic shock requiring vasopressors who are at increased risk of early death. Of these easy-to-acquire values, SI and MSI show a comparatively better performance.
感染性休克与死亡率增加相关。预测死亡率，包括对重症监护病房（ICU）中感染性休克患者的早期预测，仍然是一个重要的挑战。
我们检索了医疗信息集市-重症监护 IV 数据库。使用逻辑回归模型计算了需要升压药的感染性休克患者休克指数（SI）、改良 SI（MSI）和舒张期 SI（DSI）与 3 天/住院死亡率之间关系的比值比（OR）及其 95%置信区间（CI）。比较了存活者和非存活者之间这些参数的时间变化。通过接受者操作特征（ROC）曲线下面积（AUC）描述不同参数的性能，并与 DeLong 分析进行比较。
共确定了 1266 例需要升压药的感染性休克患者。3 天死亡率和住院死亡率分别为 8.7%和 23.5%。多变量逻辑回归分析显示，在充分调整模型中，升压前 SI/MSI/DSI 与需要升压药的感染性休克患者 3 天死亡率之间存在显著关联（趋势 P 值均<0.01）。升压前 SI、MSI 和 DSI 的 AUC 分别为 0.746、0.710 和 0.732，用于预测 3 天死亡率。需要升压药的感染性休克患者在 3 天/住院死亡率方面，存活者和非存活者之间的 SI、MSI 和 DSI 的时间变化存在显著差异（重复测量方差分析，受试者间差异 P<0.001）。
升压前 SI、MSI 和 DSI 值可识别出需要升压药的感染性休克患者，这些患者有早期死亡的高风险。在这些易于获取的数值中，SI 和 MSI 表现出相对较好的性能。
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