Naidoo-Pillay Amanda, Rajan Suma, Engelbrecht Andreas
Division of Emergency Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Division of Emergency Medicine, Faculty of Health Sciences, Steve Biko Academic Hospital, Pretoria, South Africa.
J Coll Med S Afr. 2025 Jul 24;3(1):193. doi: 10.4102/jcmsa.v3i1.193. eCollection 2025.
Decompensated heart failure (HF) is a serious condition that requires rapid evaluation and treatment. Shock index (SI) is a bedside predictor tool used to identify risk of mortality and morbidity.
This multicentre retrospective descriptive study evaluated SI, modified shock index (MSI) and reverse shock index (RSI) as predictors of mortality in decompensated HF. Emergency department records for a 6-month period were analysed. The primary outcome was to identify if SI > 0.9 could predict mortality during hospital admission. Secondary outcomes included SI > 0.9, MSI > 0.93 and RSI < 1 for prediction of 72-h mortality, use of non-invasive positive pressure ventilation, inotropic, vasopressor or nitroglycerine infusions and need for endotracheal intubation.
Overall mortality during hospital admission was 4.3%, impacting internal validity. For inotrope use, SI > 0.9 at 12 h produced an odds ratio (OR) of 12.33 (confidence interval [CI] 2.03-74.89; = 0.006). Modified shock index > 0.93 suggested potential for mortality and critical intervention prediction but lacked statistical significance. Reverse shock index < 1.0 at 0 h indicated ORs of 8.89 (CI 1.11-70.98) for in-hospital mortality and 9.88 (CI 1.70-57.27) for inotrope use.
SI > 0.9 at 12 h predicted an increased need for inotropes. Reverse shock index demonstrates significant predictive value for mortality and critical interventions in decompensated HF. Reverse shock index appears to be the most effective index in predicting both mortality and need for critical interventions, outperforming SI and MSI. Further prospective studies are needed to validate these findings.
This research will assist with early triage of decompensated HF patients to appropriate dispositions and guide inexperienced clinicians to identify high-risk patients.
失代偿性心力衰竭（HF）是一种严重疾病，需要快速评估和治疗。休克指数（SI）是一种用于识别死亡和发病风险的床边预测工具。
这项多中心回顾性描述性研究评估了SI、改良休克指数（MSI）和反向休克指数（RSI）作为失代偿性HF患者死亡率的预测指标。分析了6个月期间急诊科的记录。主要结局是确定SI>0.9是否可预测住院期间的死亡率。次要结局包括SI>0.9、MSI>0.93和RSI<1对72小时死亡率的预测、无创正压通气的使用、使用强心剂、血管加压药或硝酸甘油输注以及气管插管的需求。
住院期间的总体死亡率为4.3%，影响内部效度。对于使用强心剂，12小时时SI>0.9的比值比（OR）为12.33（置信区间[CI]2.03 - 74.89；P = 0.006）。改良休克指数>0.93提示有死亡和进行关键干预预测的可能性，但缺乏统计学意义。0小时时反向休克指数<1.0表明住院死亡率的OR为8.89（CI 1.11 - 70.98），使用强心剂的OR为9.88（CI 1.70 - 57.27）。
12小时时SI>0.9预测强心剂使用需求增加。反向休克指数对失代偿性HF患者的死亡率和关键干预具有显著预测价值。反向休克指数似乎是预测死亡率和关键干预需求最有效的指标，优于SI和MSI。需要进一步的前瞻性研究来验证这些发现。
本研究将有助于对失代偿性HF患者进行早期分诊，使其得到适当处置，并指导经验不足的临床医生识别高危患者。
