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Original article
Available online 25 July 2024
Assessment of the shock index in septic shock: A systematic review
Evaluación del índice de shock en choque séptico: una revisión sistemática
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Juan José Diaztagle Fernándeza,
Corresponding author
jjdiaztagle@fucsalud.edu.co

Corresponding author.
, Juan Pablo Castañeda-Gonzálezb, José Ignacio Trujillo Zambranoc, Francy Esmith Duarte Martínezc, Miguel Ángel Saavedra Ortizc
a Servicio de Medicina Interna, Fundación Universitaria de Ciencias de la Salud – FUCS, Hospital de San José de Bogotá. Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
b Semillero de Investigación en Medicina Interna, Fundación Universitaria de Ciencias de la Salud – FUCS, Bogotá, Colombia
c Servicio de Medicina de Urgencias, Fundación Universitaria de Ciencias de la Salud – FUCS, Bogotá, Colombia
This item has received
Received 27 December 2023. Accepted 23 June 2024
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Figures (2)
Tables (3)
Table 1. Descriptive data of included studies.
Table 2. Prognostic evaluation of SI value in septic shock population.
Table 3. Prognostic evaluation of MSI and DSI values in septic shock population.
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Abstract
Objective

To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions.

Design

Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Settings

The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs.

Patients

Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded.

Interventions

Studies reporting measurement of the shock index or its modified variants.

Main variables of interest

Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study.

Results

Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality.

Conclusions

The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.

Keywords:
Sepsis
Septic shock
Lactate
Shock index
Resuscitation
Resumen
Objetivo

Identificar las investigaciones publicadas sobre el Índice de Shock (IS) en pacientes con choque séptico o sepsis severa y describir sus principales resultados y conclusiones.

Diseño

Revisión sistemática de la literatura siguiendo las recomendaciones del protocolo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Ámbito

Se consultaron las bases de datos: Pubmed, Embase, Library Cochrane y Lilacs.

Pacientes

Pacientes mayores de 14 años con choque séptico. Se excluyeron mujeres embarazadas y población con COVID-19.

Intervenciones

Estudios que reportaran la medición del índice de choque o sus variantes modificadas.

Variables de interés principales

Se evaluaron frecuencias absolutas y frecuencias relativas con medidas de tendencia central y dispersión. Se extrajeron estimadores de efecto (OR, RR y HR) según el contexto de cada estudio.

Resultados

Se incluyeron 17 artículos, de los cuales 11 investigaron el IS como un predictor de mortalidad. 7 encontraron diferencias significativas en el IS al comparar supervivientes de no supervivientes, y observaron una relación entre la evolución del IS y los resultados clínicos. Investigaciones adicionales evidenciaron una relación entre el Índice de Shock Modificado y la depresión miocárdica, así como con la mortalidad. Además, identificaron una relación entre el Índice de Shock Diastólico, la dosis de dobutamina administrada y la mortalidad.

Conclusiones

Los resultados sugieren que tanto el IS como sus versiones modificadas, principalmente en evaluaciones seriadas, pueden ser tenidos en cuenta para evaluar el pronóstico del paciente. El IS también puede ser útil en definir el uso de líquidos en los pacientes.

Palabras clave:
Sepsis
Choque séptico
Lactato
Índice de shock
Reanimación

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