Identify value of rate pressure product in children with compensatory septic shock

Septic shock is a major cause of mortality and is often difficult to recognize timely in pediatric patients. Rate pressure product (RPP) strongly correlates with oxygen consumption and is an indicator of the heart’s workload. In this article, we sought to evaluate the value of the rate pressure product (RPP) for the early identification of septic shock in children. A retrospective case–control study was conducted. Patients (age range 29 days to 18 years old) with septic shock from June 2016 to December 2022 were included. Demographic, clinical, and hemodynamic data (heart rate HR, systolic blood pressure SBP, and mean arterial pressure MAP) and arterial lactate values were reviewed. Vital signs from survivors during the post-recovery period served as the control group, irrespective of their prior shock status. Multivariate logistic regression was used to identify factors independently associated with compensatory septic shock. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting compensatory septic shock. A total of 83 patients, including 41 patients with decompensated septic shock and 42 patients with compensatory septic shock were included, and 60 of these patients survived. Correlation analysis showed that HR, SBP, MAP, and shock index (SI) were significantly associated with age; however, no significant correlation was found between RPP and age. The AUC-ROC values of HR, RPP and SI for discriminating compensatory septic shock were 0.901 (95% confidence interval CI, 0.846–0.957, P < 0.001), 0.953 (95% CI 0.911–0.995, P < 0.001), and 0.708 (95% CI 0.625–0.792, P < 0.001), respectively. In the multivariable analysis, only RPP (odds ratio, 3.921 per 1000 bpm × mmHg increase; 95% CI 2.371–6.483; P < 0.001) was significantly associated with compensatory septic shock. Moreover, the combination of RPP, age, lactate, HR and SI significantly improved risk reclassification over the combination of age, lactate, HR and SI (χ2 = 4.037, P = 0.045), with a continuous NRI (59.2%), a categorical NRI (2.38%), and IDI (2.71%). RPP appears to be relatively independent of age and may serve as a practical bedside indicator for identifying compensatory septic shock in children with sepsis.