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首页> 外文期刊>Western Journal of Emergency Medicine >The Shock Index as a Predictor of Vasopressor Use in Emergency Department Patients with Severe Sepsis
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The Shock Index as a Predictor of Vasopressor Use in Emergency Department Patients with Severe Sepsis

机译：休克指数是严重脓毒症急诊患者使用血管加压药的预测指标

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Introduction: Severe sepsis is a leading cause of non-coronary death in hospitals across the United States. Early identification and risk stratification in the emergency department (ED) is difficult because there is limited ability to predict escalation of care. In this study we evaluated if a sustained shock index (SI) elevation in the ED was a predictor of short-term cardiovascular collapse, defined as vasopressor dependence within 72 hours of initial presentation. Methods: Retrospective dual-centered cross-sectional study using patients identified in the Yale-New Haven Hospital Emergency Medicine sepsis registry. Results: We included 295 patients in the study with 47.5% (n?140) having a sustained SI elevation in the ED. Among patients with a sustained SI elevation, 38.6% (54 of 140) required vasopressors within 72 hours of ED admission contrasted to 11.6% (18 of 155) without a sustained SI elevation (p?0.0001; multivariate modeling OR 4.42 with 95% confidence intervals 2.28-8.55). In the SI elevation group the mean number of organ failures was 4.0 6 2.1 contrasted to 3.2 6 1.6 in the non-SI elevation group (p?0.0001). Conclusion: ED patients with severe sepsis and a sustained SI elevation appear to have higher rates of short-term vasopressor use, and a greater number of organ failures contrasted to patients without a sustained SI elevation. An elevated SI may be a useful modality to identify patients with severe sepsis at risk for disease escalation and cardiovascular collapse. [West J Emerg Med. 2014;15(1):60–66.].
机译：简介：严重的败血症是导致美国医院非冠状动脉死亡的主要原因。急诊科（ED）的早期识别和风险分层很困难，因为预测护理升级的能力有限。在这项研究中，我们评估了ED中持续的休克指数（SI）升高是否是短期心血管衰竭的预测指标，定义为在初次就诊后72小时内对血管升压药的依赖性。方法：回顾性双中心横断面研究，使用耶鲁-纽黑文医院急诊医学脓毒症登记册中确定的患者。结果：我们纳入了295例患者，其中47.5％（n？140）的ED持续SI升高。 SI持续升高的患者中，ED入院72小时内需要升压药物的患者为38.6％（140个中的54个），而SI持续不升高的患者为11.6％（155个中的18个）（p？0.0001;多变量建模或4.42，置信度为95％）间隔2.28-8.55）。在SI抬高组中，平均器官衰竭次数为4.0 6 2.1，而在非SI抬高组中，平均器官衰竭次数为3.2 6 1.6（p？0.0001）。结论：患有严重败血症和持续性SI升高的ED患者似乎短期使用升压药的比率更高，与没有持续性SI升高的患者相比，器官衰竭的发生率更高。 SI升高可能是识别患有严重脓毒症且有疾病升级和心血管衰竭风险的患者的有用方法。 [西急救医学杂志。 2014; 15（1）：60-66。]。

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