Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke
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 pr...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.007581 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850233321135538176 |
|---|---|
| author | Phyo Kyaw Myint Shubin Sheng Ying Xian Roland A. Matsouaka Mathew J. Reeves Jeffrey L. Saver Deepak L. Bhatt Gregg C. Fonarow Lee H. Schwamm Eric E. Smith |
| author_facet | Phyo Kyaw Myint Shubin Sheng Ying Xian Roland A. Matsouaka Mathew J. Reeves Jeffrey L. Saver Deepak L. Bhatt Gregg C. Fonarow Lee H. Schwamm Eric E. Smith |
| author_sort | Phyo Kyaw Myint |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e835f20a7ff142f4b148e4c1d43b2d9a |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2018-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-e835f20a7ff142f4b148e4c1d43b2d9a2025-08-20T02:02:57ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-09-0171810.1161/JAHA.117.007581Shock Index Predicts Patient‐Related Clinical Outcomes in StrokePhyo Kyaw Myint0Shubin Sheng1Ying Xian2Roland A. Matsouaka3Mathew J. Reeves4Jeffrey L. Saver5Deepak L. Bhatt6Gregg C. Fonarow7Lee H. Schwamm8Eric E. Smith9Institute of Applied Health Sciences School of Medicine, Medical Sciences & Nutrition University of Aberdeen United KingdomDuke Clinical Research Institute Duke University School of Medicine Durham NCDuke Clinical Research Institute Duke University School of Medicine Durham NCDuke Clinical Research Institute Duke University School of Medicine Durham NCDepartment of Epidemiology and Biostatistics Michigan State University Michigan MIStroke Program Department of Neurology David Geffen School of Medicine at UCLA Los Angeles CABrigham and Women's Hospital Heart & Vascular Center Harvard Medical School Harvard University Boston MADivision of Cardiology David Geffen School of Medicine at UCLA Los Angeles CADepartment of Neurology, Stroke Service Massachusetts General Hospital Boston MACalgary Stroke Programme & Department of Clinical Neurosciences University of Calgary Calgary CanadaBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.117.007581length of staymortalityprognosisshock index |
| spellingShingle | Phyo Kyaw Myint Shubin Sheng Ying Xian Roland A. Matsouaka Mathew J. Reeves Jeffrey L. Saver Deepak L. Bhatt Gregg C. Fonarow Lee H. Schwamm Eric E. Smith Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease length of stay mortality prognosis shock index |
| title | Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke |
| title_full | Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke |
| title_fullStr | Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke |
| title_full_unstemmed | Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke |
| title_short | Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke |
| title_sort | shock index predicts patient related clinical outcomes in stroke |
| topic | length of stay mortality prognosis shock index |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.007581 |
| work_keys_str_mv | AT phyokyawmyint shockindexpredictspatientrelatedclinicaloutcomesinstroke AT shubinsheng shockindexpredictspatientrelatedclinicaloutcomesinstroke AT yingxian shockindexpredictspatientrelatedclinicaloutcomesinstroke AT rolandamatsouaka shockindexpredictspatientrelatedclinicaloutcomesinstroke AT mathewjreeves shockindexpredictspatientrelatedclinicaloutcomesinstroke AT jeffreylsaver shockindexpredictspatientrelatedclinicaloutcomesinstroke AT deepaklbhatt shockindexpredictspatientrelatedclinicaloutcomesinstroke AT greggcfonarow shockindexpredictspatientrelatedclinicaloutcomesinstroke AT leehschwamm shockindexpredictspatientrelatedclinicaloutcomesinstroke AT ericesmith shockindexpredictspatientrelatedclinicaloutcomesinstroke |