Correlation between modified shock index and severity index in predicting outcome in patients with hemorrhagic shock

Faculty of Medicine

Assiut University

Correlation between modified shock index and severity index in predicting outcome in patients with hemorrhagic shock

Research Authors
Sarah Abd El Mageed Mohammed Hassan I. M. Kotb, Ayman A. Mamdouh, Abualauon M. Abedalmohsen
Research Date
Research Department
Department of  Anesthesia and Intensive Care
Research Journal
Journal of Current Medical Research and Practice
Research Member
Abualauon Mohamed Abedalmohsen Rashwan
Research Publisher
Wolters Kluwer - Medknow
Research Website
J Curr Med Res Pract 4:231–236 © 2019 Faculty of Medicine, Assiut University 2357‑0121
Research Year
2019
Research Abstract

Introduction

 

Trauma is the main cause of death in age group less than 45 years. A lot of clinical parameters including heart rate, pulse rate, blood pressure, shock index (SI), and modified shock index (MSI) are used to predict the severity of hemorrhage in trauma patients. In 2012 Choi and colleagues proposed for the first time a new index (NI) based on lactate concentration and peripheral perfusion index for assessment of shock in a rat model. In this trial, we propose for the first time a new severity predicting index (NI) based on lactate concentration/peripheral perfusion ratio as an indicator of hemorrhage-related mortality in humans.

 

Materials and methods

 

This prospective trial is a single-center study of 122 consecutive adult polytraumatized patients with hemorrhagic shock admitted to trauma center within 6 h of the trauma, and underwent resuscitation according to the advanced trauma life support protocol (2016). Protocol-related measurements were obtained immediately after admission and over 48 h postresuscitation for metabolic perfusion parameters, serum lactate, perfusion index, and other hemodynamic parameters. The period of the study corresponds to the outcome after 48 h of admission. Resuscitation measures were considered successful when lactate levels were less than or equal to 2 mmol/l in addition to stable macrohemodynamic parameters at the end of this period.

 

Results

 

Characteristically, the survivors had NI of 40 ± 2.7 on admission, compared with 87.1 ± 13 of nonsurvivors with highly significant difference. MSI showed a significant difference (nearly doubled) between survivors and nonsurvivors. SI showed nearly the same change, nearly doubled. NI showed lower prediction value for mortality than MSI and SI (P = 0.05) 0.884, 0.905, and 0.908, respectively.

 

Conclusion

 

This study confirms, for the first time in humans, the validity of severity index as independent parameter in prediction of mortality in comparison with MSI.

 

Keywords:

 

hemorrhagic shock, lactate and perfusion index, modified shock index, severity index, shock index