Key result
Shock index ≥ 1 at hospital presentation was a moderately accurate predictor of mortality in patients with sepsis or community-acquired pneumonia, with high specificity and low sensitivity.
Why the study?
Accurately and swiftly identifying patients presenting to hospital with suspected sepsis who are at high risk of adverse outcomes is necessary to improve outcomes.
Does an elevated shock index predict death or requirement for organ support in patients with suspected sepsis or community-acquired pneumonia?
Systematic Review (n=8,697)
Does an elevated shock index predict death or requirement for organ support in patients with suspected sepsis or community-acquired pneumonia?
An elevated shock index (≥ 1) at hospital presentation is a simple and highly specific predictor of mortality in patients with suspected sepsis or community-acquired pneumonia.
May aid sepsis triage given high specificity; confirms prognostic value in systematic review evidence.
BACKGROUND: To improve outcomes for patients who present to hospital with suspected sepsis, it is necessary to accurately identify those at high risk of adverse outcomes as early and swiftly as possible. To assess the prognostic accuracy of shock index (heart rate divided by systolic blood pressure) and its modifications in patients with sepsis or community-acquired pneumonia. METHODS: An electronic search of MEDLINE, EMBASE, Allie and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Open Grey, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (WHO ITRP) was conducted from conception to 26th March 2019. Eligible studies were required to assess the prognostic accuracy of shock index or its modifications for outcomes of death or requirement for organ support either in sepsis or pneumonia. The methodological appraisal was carried out using the Downs and Black checklist. Evidence was synthesised using a narrative approach due to heterogeneity. RESULTS: Of 759 records screened, 15 studies (8697 patients) were included in this review. Shock index ≥ 1 at time of hospital presentation was a moderately accurate predictor of mortality in patients with sepsis or community-acquired pneumonia, with high specificity and low sensitivity. Only one study reported outcomes related to organ support. CONCLUSIONS: Elevated shock index at time of hospital presentation predicts mortality in sepsis with high specificity. Shock index may offer benefits over existing sepsis scoring systems due to its simplicity.
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Middleton et al. (2019) conducted a systematic review in Sepsis or community-acquired pneumonia (n=8,697). Shock index ≥ 1 was evaluated on Mortality or requirement for organ support. Shock index ≥ 1 at hospital presentation was a moderately accurate predictor of mortality in patients with sepsis or community-acquired pneumonia, with high specificity and low sensitivity.
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