The Need for Hemodynamic Support of Patients with Sepsis

Yıl 2020, Cilt: 17 Sayı: 2, 172 - 176, 20.08.2020

Esra Çakır , Ahmet Bindal , Pakize Özçiftci Yılmaz , Cihangir Doğu , Işıl Özkoçak Turan

https://doi.org/10.35440/hutfd.722382

Öz

Background: Septic patients may need inotropic support due to septic shock. There is no sufficient high-sensitive parameters in order to predict the need of inotropes, in septic patients. In this study, we aimed to determine the availability of shock index (SI), modified shock index (MSI) and age shock index (ASI) for the prediction of the need for inotrope usage in septic patients in intensive care units (ICU).
Materials and Methods: We retrospectively evaluated the results of patients with sepsis who were hospitalized in ICU, between September 1, 2017 and December 31, 2018. We recorded age, gender, co-morbidities, acute physiology and chronic health evaluation II (APACHE II) scores, length of mechanical ventilation, length of hospital stay, inotropic support, SI, MSI and ASI.
Results: Our study included 233 patients with sepsis. SI, MSI, ASI levels were found out to be statistically significantly higher in patients who did require inotropic support, compared with patients who did not receive inotropic support (p < 0.05). For SI, the area beneath the receiver operating characteristic (ROC) curve was 0.765 (95% confidence interval (CI): 0.706–0.818, p = 0.0001) and cut-off value for inotropic support was 1.06 (sensitivity: 77.2 %, 95% CI: 67.1-85.5; specificity: 70.3%, 95% CI: 62.2-77.6). For MSI, the area beneath the ROC curve was 0.753 (95% CI: 0.692–0.807, p = 0.0001) and cut-off value for inotropic support was 1.56 (sensitivity: 68.2%, 95% CI: 57.4-77.7; specificity: 70.3%, 95% CI: 62.2-77.6). For ASI, the area beneath the ROC curve was 0.707 (95% CI: 0.644–0.764, p = 0.0001) and cut-off value for inotropic support was 82.4 (sensitivity: 64.7%, 95% CI: 539–74.7; specificity: 70.3%, 95% CI: 6.22–77.6).
Conclusion: Our data showed all the shock indices had mid-level prediction power for the need of inotropes.

Sepsisli Hastaların Hemodinamik Destek İhtiyacı

Öz

Amaç: Septik hastalar septik şok nedeniyle inotropik desteğe ihtiyaç duyabilir. Septik hastalarda inotropların ihtiyacını tahmin etmek için yeterli ve yüksek duyarlı parametre yoktur. Bu çalışmada yoğun bakım ünitesindeki (YBÜ) septik hastalarda inotrop kullanım ihtiyacının öngörülmesi için şok indeksi (SI), modifiye şok indeksi (MSI) ve yaş şok indeksinin (YSI) kullanılabilirliğini belirlemeyi amaçladık.
Materyal ve metod: 1 Eylül 2017 ile 31 Aralık 2018 tarihleri arasında YBÜ'de yatan sepsisli hastaların sonuçlarını retrospektif olarak değerlendirdik. Yaş, cinsiyet, eşlik eden hastalıklar, akut fizyoloji ve kronik sağlık değerlendirme II (APACHE II) skorları, mekanik ventilasyon süresi, hastanede yatış süresi, inotrop desteği, SI, MSI ve YSI kayıt edildi.
Bulgular: Çalışmamıza 233 sepsisli hasta dahil edildi. Şok indeksi, MSI ve YSI düzeyleri inotrop desteği alan sepsis hastalarında inotrop desteği almayan sepsis hastalarına göre istatistiksel olarak yüksek bulundu (p<0,05). Şok indeksi için ROC (receiver operating characteristic) eğrisi altındaki alan 0,765’tir (% 95 güven aralığı (GA): 0,706-0,818 P = 0,0001). İnotrop destek için SI eşik değeri 1,06’dır (duyarlılık: %77,2, %95 GA: 67,1-85,5, özgüllük: %70,3, %95 GA: 62,2-77,6). MSI için ROC eğrisi altındaki alan 0,753’tür (% 95 GA: 0,692-0,807 P = 0,0001). İnotrop destek için MSI eşik değeri 1,56’dır (duyarlılık: %68,2 %95 GA: 57,4-77,7, özgüllük: %70,3, %95 GA: 62,2-77,6). Yaş SI için ROC eğrisi altındaki alan 0,707’dir (% 95 GA: 0,644-0,764 P = 0,0001). İnotrop destek için YSI eşik değeri 82,4’tür (duyarlılık: %64,7, %95 GA: 53,9-74,7, özgüllük: %70,3, %95 GA: 62,2-77,6).
Sonuç: Sonuçlarımız, tüm şok indekslerinin inotrop ihtiyacı için orta seviye tahmin gücüne sahip olduğunu gösterdi.

Anahtar Kelimeler

İnotrop, Yoğun Bakım Ünitesi, Şok İndeksi, Modifiye Şok İndeksi, Yaş Şok İndeksi, Sepsis

Kaynakça

• Referans1 Tseng J, Nugent K. Utility of the shock index in patients with sepsis. Am J Med Sci. 2015;349(6):531-5.
• Referans2 Sakr Y, Jaschinski U, Wittebole X, et al. Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit. Open Forum Infect Dis. 2018;5(12):ofy313.
• Referans3 Ogura T, Nakamura Y, Takahashi K, Nishida K, Kobashi D, Matsui S. Treatment of patients with sepsis in a closed intensive care unit is associated with improved survival: a nationwide observational study in Japan. J Intensive Care. 2018;6:57.
• Referans4 Armstrong BA, Betzold RD, May AK. Sepsis and Septic Shock Strategies. Surg Clin North Am. 2017;97(6):1339-79.
• Referans5 Vallabhajosyula S, Jentzer JC, Kotecha AA, et al. Development and performance of a novel vasopressor-driven mortality prediction model in septic shock. Ann Intensive Care. 2018;8(1):112.
• Referans6 Nagendran M, Maruthappu M, Gordon AC, Gurusamy KS. Comparative safety and efficacy of vasopressors for mortality in septic shock: A network meta-analysis. J Intensive Care Soc. 2016;17(2):136-145.
• Referans7 Torabi M, Moeinaddini S, Mirafzal A, Rastegari A, Sadeghkhani N. Shock index, modified shock index, and age shock index for prediction of mortality in Emergency Severity Index level 3. Am J Emerg Med. 2016;34(11):2079-2083.
• Referans8 Jayaprakash N, Gajic O, Frank RD, Smischney N. Elevated modified shock index in early sepsis is associated with myocardial dysfunction and mortality. J Crit Care. 2018;43:30-35.
• Referans9 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
• Referans10 Personett HA, Stollings JL, Cha SS, Oyen LJ. Predictors of prolonged vasopressin infusion for the treatment of septic shock. J Crit Care. 2012;27(3):318.e7-12.
• Referans11 Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552.
• Referans12 Wang IJ, Bae BK, Park SW, et al. Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients. Am J Emerg Med. 2019. pii: S0735-6757(19)30034-8.
• Referans13 Kny KT, Ferreira MAP, Pizzol TDSD. Use of vasopressin in the treatment of refractory septic shock. Rev Bras Ter Intensiva. 2018;30(4):423-428.
• Referans14 Zhou F, Mao Z, Zeng X, et al. Vasopressors in septic shock: a systematic review and network meta-analysis. Ther Clin Risk Manag. 2015;11:1047-59.
• Referans15 Rasmy I, Mohamed H, Nabil N, et al. Evaluation of Perfusion Index as a Predictor of Vasopressor Requirement in Patients with Severe Sepsis. Shock. 2015;44(6):554-9.
• Referans16 Thongprayoon C, Cheungpasitporn W, Harrison AM, et al. Temporal trends in the utilization of vasopressors in intensive care units: an epidemiologic study. BMC Pharmacol Toxicol. 2016;17(1):19.
• Referans17 Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
• Referans18 Xu JY, Ma SQ, Pan C, et al. A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study. Crit Care. 2015;19:130.
• Referans19 Holder AL, Gupta N, Lulaj E, et al. A. Predictors of early progression to severe sepsis or shock among emergency department patients with nonsevere sepsis. Int J Emerg Med. 2016;9(1):10.
• Referans20 Xing XZ, Wang HJ, Huang CL, et al. Prognosis of patients with shock receiving vasopressors. World J Emerg Med. 2013;4(1):59-62. Referans21 Wira CR, Francis MW, Bhat S, Ehrman R, Conner D, Siegel M. The shock index as a predictor of vasopressor use in emergency department patients with severe sepsis. West J Emerg Med. 2014;15(1):60-6.
• Referans22 Smischney NJ, Seisa MO, Heise KJ, Schroeder DR, Weister TJ, Diedrich DA. Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically III. J Intensive Care Med. 2018;33(10):582-8.
• Referans23 Mann B, Hough C, Carlbom D. Shock Index as a Predictor of Hospital Outcomes in Patients With Sepsis. Chest. 2015;148(4_MeetingAbstracts):350A.