A diastolic shock index (DSI) of 2.0 or greater is associated with increased mortality and demonstrates superior predictive value for septic shock progression compared to heart rate and systolic SI.
Does the diastolic shock index (DSI) predict progression to septic shock and mortality better than MAP or systolic SI in patients with sepsis?
The diastolic shock index (HR/DBP) may serve as a superior early predictor for progression to septic shock and mortality compared to traditional hemodynamic markers.
In septic shock, hypotension is primarily caused by the failure of vascular smooth muscle to constrict, leading to systemic vasodilation and eventual diastolic dysfunction. Therefore, the diastolic shock index (DSI) may be a more appropriate measure than mean arterial pressure (MAP) or systolic shock index (SI) for quantifying the severity of septic shock. A DSI of 2.0 or greater has been associated with increased mortality and demonstrates superior predictive value compared to heart rate (HR) and systolic SI alone. The DSI is calculated as: DSI = HR / DBP. Its early calculation can predict progression to septic shock before hemodynamic instability manifests, thereby enabling clinicians to initiate prompt treatment for sepsis and potentially avert overt shock. Furthermore, DSI may also serve as a valuable predictor of mortality in patients with sepsis.
Mel et al. (2026) conducted a review in Septic shock. Diastolic shock index (DSI) vs. Mean arterial pressure (MAP) or systolic shock index (SI) was evaluated on Progression to septic shock and mortality. A diastolic shock index (DSI) of 2.0 or greater is associated with increased mortality and demonstrates superior predictive value for septic shock progression compared to heart rate and systolic SI.