Key result
A baseline preoperative shock index ≥ 0.9 was significantly associated with an increased risk of post-spinal hypotension (AOR 2.77) in parturients undergoing non-elective cesarean section.
Why the study?
In the obstetric population, shock index of ≥ 0.9 is associated with maternal adverse outcomes, but its association with post-spinal hypotension in non-elective cesarean section required investigation.
Does a preoperative shock index ≥ 0.9 predict post-spinal and post-delivery hypotension in parturients undergoing non-elective cesarean section?
Cohort (n=335)
No
Does a preoperative shock index ≥ 0.9 predict post-spinal and post-delivery hypotension in parturients undergoing non-elective cesarean section?
Odds Ratio: 2.77 (95% CI 1.15–6.66)
Absolute Event Rate: 58.18% vs 43.93%
p-value: p=0.023
A preoperative shock index ≥ 0.9 is an independent predictor of post-spinal and post-delivery hypotension in women undergoing non-elective cesarean section under spinal anesthesia.
May support preoperative risk stratification in non-elective cesarean delivery; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section. METHODS: In this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves. RESULTS: Three hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15-6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14-4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72-10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06-1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49-0.57) and 0.56 (95%CI 0.51-0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively. CONCLUSION: In parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability. TRIAL REGISTRATION: Registration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov .
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Silwal et al. (2024) conducted a cohort in Non-elective cesarean section (n=335). Preoperative shock index ≥ 0.9 vs. Preoperative shock index < 0.9 was evaluated on Post-spinal hypotension (before delivery) (AOR 2.77, 95% CI 1.15-6.66, p=0.023). A baseline preoperative shock index ≥ 0.9 was significantly associated with an increased risk of post-spinal hypotension (AOR 2.77) in parturients undergoing non-elective cesarean section.
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