Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Phyo Kyaw Myint* (Corresponding Author), 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)
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Abstract

BackgroundThe 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 ResultsWe 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.ConclusionsSI 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.
Original languageEnglish
Article numbere007581
Number of pages47
JournalJournal of the American Heart Association
Volume7
Issue number18
Early online date7 Sept 2018
DOIs
Publication statusPublished - 18 Sept 2018

Bibliographical note

The Get With The Guidelines–Stroke (GWTG-Stroke) program is currently supported in part by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in the design or analysis, article preparation, or approval of this study.

Keywords

  • length of stay
  • prognosis
  • mortality
  • shock index

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