Shock Index Predicts Patient-Related Clinical Outcomes in Stroke.

Myint, Phyo Kyaw

Sheng, Shubin

Xian, Ying

Matsouaka, Roland A

Reeves, Mathew J

Saver, Jeffrey L

Bhatt, Deepak L

Fonarow, Gregg C

Schwamm, Lee H

Smith, Eric E

2020-10-27T17:29:00Z

2020-10-27T17:29:00Z

2018-09

2020-10-27T17:28:58Z

Background The prognostic value of shock index ( SI ), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood. Methods and Results We examined the Get With The Guidelines-Stroke ( GWTG -Stroke) data to explore the usefulness of SI in predicting in-hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [ CI ], 1.92-2.08) for in-hospital mortality, 1.46 (95% CI , 1.43-1.49) for longer length of hospital stay >4 days, 1.50 (95% CI , 1.47-1.54) for discharge destination other than home, 1.41 (95% CI , 1.38-1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI , 1.47-1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG -Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS . Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.

2047-9980

2047-9980

https://hdl.handle.net/10161/21637

eng

Ovid Technologies (Wolters Kluwer Health)

Journal of the American Heart Association

10.1161/jaha.117.007581

Humans

Acute Disease

Shock

Prognosis

Severity of Illness Index

Incidence

Hospital Mortality

Survival Rate

Retrospective Studies

Follow-Up Studies

Blood Pressure

Aged

United States

Female

Male

Stroke

Global Health

Shock Index Predicts Patient-Related Clinical Outcomes in Stroke.

Journal article

Xian, Ying|0000-0002-1237-1162

Matsouaka, Roland A|0000-0002-0271-5400

e007581

18

School of Medicine

Duke Clinical Research Institute

Neurology, Neurocritical Care

Medicine, Clinical Pharmacology

Duke

Institutes and Centers

Neurology

Clinical Science Departments

Medicine

Biostatistics & Bioinformatics

Basic Science Departments

Published

7