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Abstract PD-024: SHOCK INDEX BETTER PREDICTOR OF EARLY MORTALITY IN PAEDIATRIC SEPTIC SHOCK IN COMPARISON TO CONVENTIONAL HEMODYNAMIC VARIABLES

Gupta, S.1; Alam, A.2

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 36
doi: 10.1097/01.pcc.0000537426.43912.9d
Poster Discussion Abstracts
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1King George’s Medical University, Department of Pediatrics, Lucknow, India

2King George’s Medical University, Pediatrics, Lucknow, India

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Aims & Objectives:

Normalization of hemodynamic variables including heart rate (HR) and blood pressure (BP) does not necessarily improve the outcome. Identification of a better parameter would guide in effective triaging and targeted management. Therefore this work compare the predictive value of the shock index at 0 and 6 hours with HR and BP in severe sepsis and septic shock.

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Methods

Prospective observational study.

The study included 120 patients of severe sepsis or septic shock admitted from July 2015 to June 2016. Systolic BP (SBP), heart rate (HR) and shock index (SI=HR/SBP) were measured at admission (X0) and at 6 hours (X6). The patients were divided into 3 groups: Group 1: <1year, Group 2: 1 to <6yrs, Group 3: ≥6 years. Death within 48 hours of admission was the primary outcome. The area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for each parameter was calculated. The outcome measure was the mortality in 48 hours.

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Results

Early mortality was 50%. SI0 had highest AUROC than HR0 or SBP0 in group 1(0.7,0.6,0.6), group 2(0.7,0.6,0.6) and group 3(0.8,0.6,0.8). At 6 hours, SI predicted mortality better than HR or SBP in group 1(0.8,0.7,0.76), group 2(0.8,0.7,0.7) and group 3(0.8,0.7,0.8). SI0 had better NPV in all age groups (92–98%), in comparison to HR0 (88–90%) and SBP0 (91–94%). SI6 also had better NPV (94–97%) than HR6 (88–94%) or SBP6 (90–95%) in all age groups.

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Conclusions

SI may better predict early mortality in severe sepsis and septic shock as compared to HR and BP.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies