Prognostic value of the shock index and modified shock index in survivors of out-of-hospital cardiac arrest:  A retrospective cohort study

K.M.G. van Bergen; L. van Kooten; C.G.M.J. Eurlings; N.A. Foudraine; H. Lameijer; J.G. Meeder; B.M. Rahel; M.G.J. Versteegen; F.H.M. van Osch; D.G. Barten

doi:10.1016/j.ajem.2022.05.039

Prognostic value of the shock index and modified shock index in survivors of out-of-hospital cardiac arrest: A retrospective cohort study

K.M.G. van Bergen, L. van Kooten, C.G.M.J. Eurlings, N.A. Foudraine, H. Lameijer, J.G. Meeder, B.M. Rahel, M.G.J. Versteegen, F.H.M. van Osch^*, D.G. Barten

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: There is a lack of rapid, non-invasive tools that aid early prognostication in patients with return of spontaneous circulation (ROSC) after Out-of-Hospital Cardiac Arrest (OHCA). The shock index (SI) and modified shock index (MSI) have shown to be useful in several medical conditions, including myocardial infarction. In this study, we assessed the prognostic value of SI and MSI at Emergency Department (ED) triage on survival to discharge of OHCA patients. Methods: A single-center retrospective observational cohort study. All OHCA patients with a period of ROSC between 2014 and 2019 were included. Data collection was based on the Utstein criteria. The SI and MSI at ED triage were calculated by dividing heart rate by systolic blood pressure or mean arterial pressure. Survival rates were compared between patients with a high and low SI and MSI. Subsequent Cox regression analysis was performed.Main results: A total of 403 patients were included, of which 46% survived until hospital discharge. An elevated SI and MSI was defined by SI >_ 1.00 and MSI >_ 1.30. Survival to discharge, 30 -day-and one-year survival were significantly lower in patients with an elevated SI and MSI (p < 0.001). An elevated SI and MSI was also associated with a higher rate of recurrent loss of circulation in the ED (p < 0.001). The 30-day survival hazard ratio was 2.24 (1.56-3.22) for SI and 2.46 (1.71-3.53) for MSI; the one-year survival hazard ratio was 2.20 (1.54-3.15) for SI and 2.38 (1.66-3.40) for MSI.Conclusion: Survival to discharge and 30-day survival are lower in OHCA patients with an elevated SI and MSI at ED triage. Further studies are warranted to elucidate the causational mechanisms underlying the association between elevated SI or MSI and worse outcomes.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

Original language	English
Pages (from-to)	175-185
Number of pages	11
Journal	American Journal of Emergency Medicine
Volume	58
DOIs	https://doi.org/10.1016/j.ajem.2022.05.039
Publication status	Published - 1 Aug 2022

Keywords

Out-of-hospital cardiac arrest
Resuscitation
Shock index
Survival
Prognosis
Modified shock index
AMERICAN-HEART-ASSOCIATION
CARDIOPULMONARY-RESUSCITATION
MYOCARDIAL DYSFUNCTION
EUROPEAN RESUSCITATION
CARE
GUIDELINES
PREDICTOR
MORTALITY
ADMISSION
OUTCOMES

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van Bergen, K. M. G., van Kooten, L., Eurlings, C. G. M. J., Foudraine, N. A., Lameijer, H., Meeder, J. G., Rahel, B. M., Versteegen, M. G. J., van Osch, F. H. M., & Barten, D. G. (2022). Prognostic value of the shock index and modified shock index in survivors of out-of-hospital cardiac arrest: A retrospective cohort study. American Journal of Emergency Medicine, 58, 175-185. https://doi.org/10.1016/j.ajem.2022.05.039

@article{ab56f6d7cebd427e8de12867d310467f,

title = "Prognostic value of the shock index and modified shock index in survivors of out-of-hospital cardiac arrest: A retrospective cohort study",

abstract = "Background: There is a lack of rapid, non-invasive tools that aid early prognostication in patients with return of spontaneous circulation (ROSC) after Out-of-Hospital Cardiac Arrest (OHCA). The shock index (SI) and modified shock index (MSI) have shown to be useful in several medical conditions, including myocardial infarction. In this study, we assessed the prognostic value of SI and MSI at Emergency Department (ED) triage on survival to discharge of OHCA patients. Methods: A single-center retrospective observational cohort study. All OHCA patients with a period of ROSC between 2014 and 2019 were included. Data collection was based on the Utstein criteria. The SI and MSI at ED triage were calculated by dividing heart rate by systolic blood pressure or mean arterial pressure. Survival rates were compared between patients with a high and low SI and MSI. Subsequent Cox regression analysis was performed.Main results: A total of 403 patients were included, of which 46% survived until hospital discharge. An elevated SI and MSI was defined by SI >_ 1.00 and MSI >_ 1.30. Survival to discharge, 30 -day-and one-year survival were significantly lower in patients with an elevated SI and MSI (p < 0.001). An elevated SI and MSI was also associated with a higher rate of recurrent loss of circulation in the ED (p < 0.001). The 30-day survival hazard ratio was 2.24 (1.56-3.22) for SI and 2.46 (1.71-3.53) for MSI; the one-year survival hazard ratio was 2.20 (1.54-3.15) for SI and 2.38 (1.66-3.40) for MSI.Conclusion: Survival to discharge and 30-day survival are lower in OHCA patients with an elevated SI and MSI at ED triage. Further studies are warranted to elucidate the causational mechanisms underlying the association between elevated SI or MSI and worse outcomes.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).",

keywords = "Out-of-hospital cardiac arrest, Resuscitation, Shock index, Survival, Prognosis, Modified shock index, AMERICAN-HEART-ASSOCIATION, CARDIOPULMONARY-RESUSCITATION, MYOCARDIAL DYSFUNCTION, EUROPEAN RESUSCITATION, CARE, GUIDELINES, PREDICTOR, MORTALITY, ADMISSION, OUTCOMES",

author = "{van Bergen}, K.M.G. and {van Kooten}, L. and C.G.M.J. Eurlings and N.A. Foudraine and H. Lameijer and J.G. Meeder and B.M. Rahel and M.G.J. Versteegen and {van Osch}, F.H.M. and D.G. Barten",

year = "2022",

month = aug,

day = "1",

doi = "10.1016/j.ajem.2022.05.039",

language = "English",

volume = "58",

pages = "175--185",

journal = "American Journal of Emergency Medicine",

issn = "0735-6757",

publisher = "W.B. Saunders Ltd",

}

van Bergen, KMG, van Kooten, L, Eurlings, CGMJ, Foudraine, NA, Lameijer, H, Meeder, JG, Rahel, BM, Versteegen, MGJ, van Osch, FHM & Barten, DG 2022, 'Prognostic value of the shock index and modified shock index in survivors of out-of-hospital cardiac arrest: A retrospective cohort study', American Journal of Emergency Medicine, vol. 58, pp. 175-185. https://doi.org/10.1016/j.ajem.2022.05.039

TY - JOUR

T1 - Prognostic value of the shock index and modified shock index in survivors of out-of-hospital cardiac arrest

T2 - A retrospective cohort study

AU - van Bergen, K.M.G.

AU - van Kooten, L.

AU - Eurlings, C.G.M.J.

AU - Foudraine, N.A.

AU - Lameijer, H.

AU - Meeder, J.G.

AU - Rahel, B.M.

AU - Versteegen, M.G.J.

AU - van Osch, F.H.M.

AU - Barten, D.G.

PY - 2022/8/1

Y1 - 2022/8/1

N2 - Background: There is a lack of rapid, non-invasive tools that aid early prognostication in patients with return of spontaneous circulation (ROSC) after Out-of-Hospital Cardiac Arrest (OHCA). The shock index (SI) and modified shock index (MSI) have shown to be useful in several medical conditions, including myocardial infarction. In this study, we assessed the prognostic value of SI and MSI at Emergency Department (ED) triage on survival to discharge of OHCA patients. Methods: A single-center retrospective observational cohort study. All OHCA patients with a period of ROSC between 2014 and 2019 were included. Data collection was based on the Utstein criteria. The SI and MSI at ED triage were calculated by dividing heart rate by systolic blood pressure or mean arterial pressure. Survival rates were compared between patients with a high and low SI and MSI. Subsequent Cox regression analysis was performed.Main results: A total of 403 patients were included, of which 46% survived until hospital discharge. An elevated SI and MSI was defined by SI >_ 1.00 and MSI >_ 1.30. Survival to discharge, 30 -day-and one-year survival were significantly lower in patients with an elevated SI and MSI (p < 0.001). An elevated SI and MSI was also associated with a higher rate of recurrent loss of circulation in the ED (p < 0.001). The 30-day survival hazard ratio was 2.24 (1.56-3.22) for SI and 2.46 (1.71-3.53) for MSI; the one-year survival hazard ratio was 2.20 (1.54-3.15) for SI and 2.38 (1.66-3.40) for MSI.Conclusion: Survival to discharge and 30-day survival are lower in OHCA patients with an elevated SI and MSI at ED triage. Further studies are warranted to elucidate the causational mechanisms underlying the association between elevated SI or MSI and worse outcomes.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

AB - Background: There is a lack of rapid, non-invasive tools that aid early prognostication in patients with return of spontaneous circulation (ROSC) after Out-of-Hospital Cardiac Arrest (OHCA). The shock index (SI) and modified shock index (MSI) have shown to be useful in several medical conditions, including myocardial infarction. In this study, we assessed the prognostic value of SI and MSI at Emergency Department (ED) triage on survival to discharge of OHCA patients. Methods: A single-center retrospective observational cohort study. All OHCA patients with a period of ROSC between 2014 and 2019 were included. Data collection was based on the Utstein criteria. The SI and MSI at ED triage were calculated by dividing heart rate by systolic blood pressure or mean arterial pressure. Survival rates were compared between patients with a high and low SI and MSI. Subsequent Cox regression analysis was performed.Main results: A total of 403 patients were included, of which 46% survived until hospital discharge. An elevated SI and MSI was defined by SI >_ 1.00 and MSI >_ 1.30. Survival to discharge, 30 -day-and one-year survival were significantly lower in patients with an elevated SI and MSI (p < 0.001). An elevated SI and MSI was also associated with a higher rate of recurrent loss of circulation in the ED (p < 0.001). The 30-day survival hazard ratio was 2.24 (1.56-3.22) for SI and 2.46 (1.71-3.53) for MSI; the one-year survival hazard ratio was 2.20 (1.54-3.15) for SI and 2.38 (1.66-3.40) for MSI.Conclusion: Survival to discharge and 30-day survival are lower in OHCA patients with an elevated SI and MSI at ED triage. Further studies are warranted to elucidate the causational mechanisms underlying the association between elevated SI or MSI and worse outcomes.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

KW - Out-of-hospital cardiac arrest

KW - Resuscitation

KW - Shock index

KW - Survival

KW - Prognosis

KW - Modified shock index

KW - AMERICAN-HEART-ASSOCIATION

KW - CARDIOPULMONARY-RESUSCITATION

KW - MYOCARDIAL DYSFUNCTION

KW - EUROPEAN RESUSCITATION

KW - CARE

KW - GUIDELINES

KW - PREDICTOR

KW - MORTALITY

KW - ADMISSION

KW - OUTCOMES

U2 - 10.1016/j.ajem.2022.05.039

DO - 10.1016/j.ajem.2022.05.039

M3 - Article

C2 - 35696802

SN - 0735-6757

VL - 58

SP - 175

EP - 185

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

ER -