Sepsis
Conditions
Keywords
Modified shock index
Brief summary
The Emergence of Modified Shock Index (MSI) To further enhance the assessment of hemodynamic stability, the modified shock index (MSI) was developed. The MSI is defined as the ratio of heart rate to mean arterial pressure (MAP) This index takes into account the effect of diastolic blood pressure by replacing SBP with MAP in the calculation . The modified shock index has proven to be a superior predictor of mortality compared to traditional SI . It outperforms heart rate, systolic blood pressure, diastolic blood pressure, and SI as individual predictors
Detailed description
Sepsis is defined as a "life-threatening organ dysfunction due to a dysregulated host response to infection". Despite high treatment expense, sepsis is often fatal . Many a times, Sepsis is diagnosed late, and proper treatment is delayed. When Sepsis is identified early in emergency department (ED) and aggressive therapy is initiated early, the mortality and morbidity rates can be significantly reduced because most cases of sepsis present in the ED and in the wards rather than the intensive care unit (ICU) Septic shock is a subset of sepsis characterized by persistent circulatory, cellular, and metabolic abnormalities associated with a higher risk of mortality,Clinically (Sepsis-3 definition) :- Sepsis with hypotension requiring vasopressors to maintain/ MAP ≥ 65 mmHg/AND serum lactate \> 2 mmol/L/ Despite adequate fluid resuscitation The shock index (SI) is a simple and reliable formula used to evaluate the physiological response in cardiovascular performance prior to systemic hypotension. It is calculated by dividing the heart rate by the systolic blood pressure(SBP) This ratio was first introduced by Allgower and Buri in 1967 as an inexpensive method to assess the degree of hypovolemia in hemorrhagic and infectious shock The non-invasive nature of this measurement makes it valuable in providing consistent hemodynamic data. SI serves as a crucial metric for determining the level of tissue perfusion Moreover, it enables the assessment of the severity of hypovolemic shock The Emergence of Modified Shock Index (MSI) To further enhance the assessment of hemodynamic stability, the modified shock index (MSI) was developed. The MSI is defined as the ratio of heart rate to mean arterial pressure (MAP) This index takes into account the effect of diastolic blood pressure by replacing SBP with MAP in the calculation . The modified shock index has proven to be a superior predictor of mortality compared to traditional SI . It outperforms heart rate, systolic blood pressure, diastolic blood pressure, and SI as individual predictors
Interventions
OTHERChest x-ray
Smear from sputum or urine to identify the site of infection
DIAGNOSTIC_TESTCBC
Identify the infection by sepsis markers
Sponsors
Sohag University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Age ≥ 18 years Presentation to the ED with sepsis(Suspected or confirmed infection plus Evidence of organ dysfunction) (SOFA score ≥ 2 from baseline)
Exclusion criteria
* Pregnancy * \* poly traumatized patients * \* Cardiac arrest on arrival * \* Patients with significant cardiac arrhythmia including atrial fibrillation with rapid ventricular response, or pacemaker-dependent rhythms * \* Patients transferred from another hospital after initial resuscitation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Modified Shock Index in patients with sepsis presenting to the Emergency Department | At baseline (upon presentation to the Emergency Department) | To assess the Modified Shock Index (MSI), calculated as the ratio of heart rate (beats per minute) to mean arterial pressure (mmHg), in adult patients presenting with sepsis to the Emergency Department, and evaluate its prognostic value. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 1. Association between Modified Shock Index and ICU admission 2. Association between Modified Shock Index and vasopressor requirement 3-Association between MSI and need for mechanical ventilation 4_Association between MSI and length of hospital stay | 1_Within 24 hours of Emergency Department presentation. 2_During the first 24 hours of hospital admission. 3_During the first 24 hours of hospital admission. 4_From hospital admission until hospital discharge. | 1. To determine the association between the Modified Shock Index measured at Emergency Department presentation and the need for Intensive Care Unit (ICU) admission. 2. To evaluate the relationship between the Modified Shock Index measured at Emergency Department presentation and the requirement for vasopressor support. 3. To determine the association between the Modified Shock Index measured at Emergency Department presentation and the requirement for invasive mechanical ventilation. 4\_To evaluate the relationship between the Modified Shock Index measured at Emergency Department presentation and the total duration of hospital stay. |
Contacts
CONTACTHeba M Sadek, Master
CONTACTNayel A Zaki, Professor
PRINCIPAL_INVESTIGATORHeba M Sadek, Master
Sohag University
Outcome results
None listed