Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically Ill

Nathan Smischney, Mohamed O. Seisa, Katherine J. Heise, Darrell R. Schroeder, Timothy J. Weister, Daniel A. Diedrich

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: To assess whether exposure to modified shock index (MSI) in the first 24 hours of intensive care unit (ICU) admission is associated with increased in-hospital mortality. Methods: Adult critically ill patients were included in a case–control design with 1:2 matching. Cases (death) and controls (alive) were abstracted by a reviewer blinded to exposure status (MSI). Cases were matched to controls on 3 factors—age, end-stage renal disease, and ICU admission diagnosis. Results: Eighty-three cases and 159 controls were included. On univariate analysis, lorazepam administration (odds ratio [OR]: 5.75, confidence interval [CI] = 2.28-14.47; P ≤.01), shock requiring vasopressors (OR: 3.62, CI = 1.77-7.40; P ≤.01), maximum MSI (OR: 2.77 per unit, CI = 1.63-4.71; P ≤.001), and elevated acute physiologic and chronic health evaluation (APACHE) III score at 1 hour (OR: 1.41 per 10 units, CI = 1.19-1.66; P ≤.001) were associated with mortality. Maximum MSI (OR: 1.93 per unit, CI = 1.07-3.48, P =.03) and APACHE III score at 1 hour (OR: 1.29 per 10 units, CI = 1.09-1.53; P =.003) remained significant with mortality in the multivariate analysis. The optimal cutoff point for high MSI and mortality was 1.8. Conclusion: Critically ill patients who demonstrate an elevated MSI within the first 24 hours of ICU admission have a significant mortality risk. Given that MSI is easily calculated at the bedside, clinicians may institute interventions earlier which could improve survival.

Original languageEnglish (US)
Pages (from-to)582-588
Number of pages7
JournalJournal of Intensive Care Medicine
Volume33
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Critical Illness
Intensive Care Units
Shock
Mortality
Odds Ratio
Confidence Intervals
Lorazepam
Health
Hospital Mortality
Chronic Kidney Failure
Multivariate Analysis
Survival

Keywords

  • case–control
  • critical care
  • intensive care unit
  • modified shock index
  • mortality
  • risk factors

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically Ill. / Smischney, Nathan; Seisa, Mohamed O.; Heise, Katherine J.; Schroeder, Darrell R.; Weister, Timothy J.; Diedrich, Daniel A.

In: Journal of Intensive Care Medicine, Vol. 33, No. 10, 01.10.2018, p. 582-588.

Research output: Contribution to journalArticle

Smischney, Nathan ; Seisa, Mohamed O. ; Heise, Katherine J. ; Schroeder, Darrell R. ; Weister, Timothy J. ; Diedrich, Daniel A. / Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically Ill. In: Journal of Intensive Care Medicine. 2018 ; Vol. 33, No. 10. pp. 582-588.
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AU - Seisa, Mohamed O.

AU - Heise, Katherine J.

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AU - Weister, Timothy J.

AU - Diedrich, Daniel A.

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AB - Purpose: To assess whether exposure to modified shock index (MSI) in the first 24 hours of intensive care unit (ICU) admission is associated with increased in-hospital mortality. Methods: Adult critically ill patients were included in a case–control design with 1:2 matching. Cases (death) and controls (alive) were abstracted by a reviewer blinded to exposure status (MSI). Cases were matched to controls on 3 factors—age, end-stage renal disease, and ICU admission diagnosis. Results: Eighty-three cases and 159 controls were included. On univariate analysis, lorazepam administration (odds ratio [OR]: 5.75, confidence interval [CI] = 2.28-14.47; P ≤.01), shock requiring vasopressors (OR: 3.62, CI = 1.77-7.40; P ≤.01), maximum MSI (OR: 2.77 per unit, CI = 1.63-4.71; P ≤.001), and elevated acute physiologic and chronic health evaluation (APACHE) III score at 1 hour (OR: 1.41 per 10 units, CI = 1.19-1.66; P ≤.001) were associated with mortality. Maximum MSI (OR: 1.93 per unit, CI = 1.07-3.48, P =.03) and APACHE III score at 1 hour (OR: 1.29 per 10 units, CI = 1.09-1.53; P =.003) remained significant with mortality in the multivariate analysis. The optimal cutoff point for high MSI and mortality was 1.8. Conclusion: Critically ill patients who demonstrate an elevated MSI within the first 24 hours of ICU admission have a significant mortality risk. Given that MSI is easily calculated at the bedside, clinicians may institute interventions earlier which could improve survival.

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