The following is a summary of “Predicting septic shock in patients with sepsis at emergency department triage using systolic and diastolic shock index,” published in the April 2024 issue of Emergency Medicine by Jeon, et al.

Identifying patients at high risk of progressing to septic shock is crucial for timely intervention and improved outcomes. In the pathophysiology of septic shock, systemic vasodilation plays a pivotal role, prompting interest in utilizing diastolic blood pressure (DBP) as a potential predictor. For a study, researchers hypothesized that initial shock index (SI) and diastolic SI (DSI) measured at the emergency department (ED) triage could serve as predictive indicators for septic shock.

The observational study utilized data from a prospectively collected sepsis registry. The primary outcome assessed was the progression to septic shock, while secondary outcomes included time to vasopressor requirement, vasopressor dose, and disease severity based on SI and DSI. Patients were categorized into tertiles based on the first principal component of the shock index and diastolic shock index.

A total of 1,267 patients were analyzed. The area under the receiver operating characteristic curve (AUC) for predicting progression to septic shock was 0.717 for DSI and 0.707 for SI. These AUC values were significantly higher than those for conventional early warning scores. The middle tertile exhibited an adjusted odds ratio (aOR) of 1.448 (95% CI 1.074–1.953), while the upper tertile showed an aOR of 3.704 (95% CI 2.299–4.111) for progression to septic shock.

Both SI and DSI emerged as significant predictors of progression to septic shock, with DSI also showing an association with vasopressor requirement. Stratifying patients into lower, middle, and upper tertiles based on these indices could provide a simple risk assessment tool at the ED triage, facilitating early identification and intervention for patients at high risk of septic shock.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000287