Predicting Progression to Septic Shock With Blood Pressure Ratio

Research Article| September 01 2024 Predicting Progression to Septic Shock With Blood Pressure Ratio AAP Grand Rounds (2024) 52 (3): 30. https://doi.org/10.1542/gr.52-3-30 Views Icon Views Article contents Figures 52 (3): 30. https://doi.org/10.1542/gr.52-3-30 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: septic shock, sepsis, blood pressure Source: Mu CT , Lin YJ , Chen CH , et al . Diastolic/systolic blood pressure ratio for predicting febrile children with sepsis and progress to septic shock in the emergency department. BMC Emerg Med. 2024;24(1):78. doi: https://doi.org/10.1186/s12873-024-00995-y.Google Scholar Investigators from Chang Gung University, Taoyuan, Taiwan, conducted a retrospective study to identify early predictors of development of septic shock in children admitted with sepsis. Participants were children 1 month to 18 years of age, presenting to 1 of 2 pediatric emergency departments (PED) in Taiwan with suspicion of infection who had an age adjusted quick Sequential Organ Failure Assessment (qSOFA) score ≥2 in the PED. qSOFA scores are based on altered mental status and hemodynamic parameters and can be used to predict need for ICU admission and risk of mortality in patients with infection.1 The medical records of study patients were reviewed and data on laboratory test results, vital signs, and Glasgow Coma Scale abstracted. Demographic information also was collected. Data from vital signs, including heart rate (HR), systolic and diastolic blood pressure (SBP and DBP, respectively), mean arterial pressure, HR/SBP, HR/DBP, and DBP/SBP (D/S ratio) were used to develop several hemodynamic measures. For the study, the initial value for each hemodynamic measure in the PED, and maximum and minimum value during the first 24 hours of hospitalization were determined. The primary outcome was development of septic shock within 48 hours after PED presentation, using a standardized definition. The main secondary outcome was sepsis-related 28-day mortality. Demographics, laboratory tests, vital signs, and hemodynamic measures were compared in children with septic shock, and in those with sepsis not progressing to shock, using chi-square and t-tests. Variables that were associated significantly with risk of developing shock in univariate analysis were included in a multivariate logistic regression model to identify independent predictors of septic shock and/or sepsis-related 28-day mortality. For independent predictors of the outcomes, Youden's index was used to identify the threshold values that maximized sensitivity and specificity. Data were analyzed on 417 children with infection and qSOFA scores ≥2. A total of 49 patients (7.4%) developed septic shock within 48 hours. Among those with septic shock, 11 died. No patients in the sepsis group without shock died. Multiple demographic, laboratory, and hemodynamic variables were significantly different among the 2 groups on univariate analyses. However, on multivariate analysis, only minimum D/S ratio during the first 24 hours of admission was statistically associated with development of septic shock (P <0.001) or sepsis-related 28-day mortality (P = 0.002). Using a threshold of 0.52, the minimum D/S ratio had a sensitivity of 0.82, and specificity of 0.72 for predicting septic shock. The best threshold for predicting sepsis-related 28-day mortality was 0.47, yielding a sensitivity of 0.81 and specificity of 0.85. The authors conclude that D/S ratio was a practical bedside scoring system that could be used to predict the development of septic shock among children with sepsis. Dr Miller-Smith has disclosed... You do not currently have access to this content.