休克指数（SI）、改良休克指数及年龄衍生指数对急性心力衰竭预后的影响；一项系统评价与荟萃分析
Impact of shock index (SI), modified SI, and age-derivative indices on acute heart failure prognosis; A systematic review and meta-analysis.
作者信息
Vakhshoori Mehrbod, Bondariyan Niloofar, Sabouhi Sadeq, Shakarami Mehrnaz, Emami Sayed Ali, Nemati Sepehr, Tavakol Golchehreh, Yavari Behzad, Shafie Davood
机构信息
Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Medicine, Loma Linda University Medical Center, Loma Linda, California, United States of America.
出版信息
PLoS One. 2024 Dec 19;19(12):e0314528. doi: 10.1371/journal.pone.0314528. eCollection 2024.
BACKGROUND
Heart failure (HF) is still associated with quite considerable mortality rates and usage of simple tools for prognosis is pivotal. We aimed to evaluate the effect of shock index (SI) and its derivatives (age SI (ASI), modified SI (MSI), and age MSI (AMSI)) on acute HF (AHF) clinical outcomes.
METHODS
PubMed/Medline, Scopus and Web of science databases were screened with no time and language limitations till February 2024. We recruited relevant records assessed SI, ASI, MSI or AMSI with AHF clinical outcomes.
RESULTS
Eight records were selected (age: 69.44±15.05 years). Mean SI in those records reported mortality (either in-hospital or long-term death) was 0.67 (95% confidence interval (CI):0.63-0.72)). In-hospital and follow-up mortality rates in seven(n = 12955) and three(n = 5253) enrolled records were 6.18% and 10.14% with mean SI of 0.68(95%CI:0.63-0.73) and 0.72(95%CI:0.62-0.81), respectively. Deceased versus survived patients had higher SI difference (0.30, 95%CI:0.06-0.53, P = 0.012). Increased SI was associated with higher chances of in-hospital death (odds ratio (OR): 1.93, 95%CI:1.30-2.85, P = 0.001).The optimal SI cut-off point was found to be 0.79 (sensitivity: 57.6%, specificity: 62.1%). In-hospital mortality based on ASI was 6.12% (mean ASI: 47.49, 95%CI: 44.73-50.25) and significant difference was found between death and alive subgroups (0.48, 95%CI:0.39-0.57, P<0.001). Also, ASI was found to be independent in-hospital mortality predictor (OR: 2.54, 95%CI:2.04-3.16, P<0.001)). The optimal ASI cut-off point was found to be 49.6 (sensitivity: 66.3%, specificity: 58.6%). In terms of MSI (mean: 0.93, 95%CI:0.88-0.98)), significant difference was found specified by death/survival status (0.34, 95%CI:0.05-0.63, P = 0.021). AMSI data synthesis was not possible due to presence of a single record.
CONCLUSIONS
SI, ASI, and MSI are practical available tools for AHF prognosis assessment in clinical settings to prioritize high risk patients.
背景
心力衰竭（HF）的死亡率仍然相当高，使用简单的预后评估工具至关重要。我们旨在评估休克指数（SI）及其衍生指标（年龄校正休克指数（ASI）、改良休克指数（MSI）和年龄校正改良休克指数（AMSI））对急性心力衰竭（AHF）临床结局的影响。
方法
检索PubMed/Medline、Scopus和Web of science数据库，检索时间截至2024年2月，无时间和语言限制。我们纳入了评估SI、ASI、MSI或AMSI与AHF临床结局的相关记录。
结果
共筛选出8篇记录（年龄：69.44±15.05岁）。这些记录中报告有死亡率（院内死亡或长期死亡）的患者的平均SI为0.67（95%置信区间（CI）：0.63 - 0.72））。7篇纳入记录（n = 12955）的院内死亡率和3篇纳入记录（n = 5253）的随访死亡率分别为6.18%和10.14%，平均SI分别为：0.68（95%CI：0.63 - 0.73）和0.72（95%CI：0.62 - 0.81）。死亡患者与存活患者的SI差异更大（0.30，95%CI：0.06 - 0.53，P = 0.012）。SI升高与院内死亡几率增加相关（比值比（OR）：1.93，95%CI：1.30 - 2.85，P = 0.001）。最佳SI切点为0.79（敏感性：57.6%，特异性：62.1%）。基于ASI的院内死亡率为6.12%（平均ASI：47.49，95%CI：44.73 - 50.25），死亡亚组和存活亚组之间存在显著差异（0.48，95%CI：0.39 - 0.57，P<0.001）。此外，ASI被发现是独立的院内死亡预测指标（OR：2.54，95%CI：2.04 - 3.16，P<0.001）。最佳ASI切点为49.6（敏感性：66.3%，特异性：58.6%）。就MSI而言（平均值：0.93，95%CI：0.88 - 0.98），死亡/存活状态之间存在显著差异（0.34，95%CI：0.05 - 0.63，P = 0.021）。由于仅有一篇记录，无法进行AMSI的数据综合分析。
结论
SI、ASI和MSI是临床环境中评估AHF预后的实用工具，可用于对高危患者进行优先排序。
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