The reverse shock index multiplied by the Glasgow Coma Scale score can predict the need for initial resuscitation in patients suspected of sepsis

Abstract

For patients suspected of sepsis, early recognition of the need for initial resuscitation is key in management. This study evaluated the ability of a modified shock index - the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) - to predict the need for initial resuscitation in patients with sepsis. This retrospective study involved adults with infection who were admitted to a Japanese tertiary care hospital from an emergency department between January and November 2020. The rSIG, modified Early Warning Score (MEWS), quick Sequential Organ Failure Assessment (qSOFA), and original shock index (SI) values were recorded using initial vital signs. The primary outcome was the area under the receiver-operating characteristic curve (AUROC) for the composite outcome consisting of vasopressor use, mechanical ventilation, and 72-h mortality. Secondary outcomes were the AUROCs for each component of the primary outcome and 28-day mortality. As a result, the primary outcome was met by 67 of the 724 patients (9%). The AUROC was significantly higher for the rSIG than for the other tools (rSIG 0.84 [0.78 - 0.88]; MEWS 0.78 [0.71 - 0.84]; qSOFA 0.72 [0.65 - 0.79]; SI 0.80 [0.74 - 0.85]). Compared with MEWS and qSOFA, the rSIG also had a higher AUROC for vasopressor use and mechanical ventilation, but not for 72-h mortality or in-hospital mortality. The rSIG could be a simple and reliable predictor of the need for initial resuscitation in patients suspected of sepsis.

Keywords: early warning score; emergency department; resuscitation; sepsis; shock index; triage.

Figure 1.

Flow of participants through the study. ED, emergency department

Figure 2.

Comparisons of receiver operating characteristic (ROC) curves for the composite outcome consisting of vasopressor use, mechanical ventilation, and 72-h mortality. rSIG, reverse shock index multiplied by Glasgow Coma Scale score; MEWS, modified Early Warning Score; qSOFA, quick Sequential Organ Failure Assessment; SI, shock index; AUROC, area under ROC. Red, green, blue and yellow lines indicate rSIG, MEWS, qSOFA and SI respectively.

Figure 3.

Distribution of rSIG values according to whether or not the composite events of primary outcome was met. rSIG, reverse shock index multiplied by the Glasgow Coma Scale score. The composite events included vasopressor use, mechanical ventilation, and 72-h death.