Namita Jayaprakash1, Ognjen Gajic2, Ryan D Frank3, Nathan Smischney4. 1. Department of Emergency Medicine and Division of Pulmonary and Critical Care, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, United States. Electronic address: namita.njayapr1@hfhs.org. 2. Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. 3. Department Biomedical statistics and informatics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. 4. Department of Anesthesia/Critical Care Division, HEMAIR (HEModynamic and AIRway Management Group), Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
Abstract
PURPOSE: The aim of this study was to explore the association of an elevated modified shock index (MSI) in sepsis and myocardial dysfunction. METHODS: This single center exploratory retrospective cohort study was conducted at Mayo Clinic from 2011 to 2014. It includes adults admitted to the medical intensive care unit with severe sepsis or septic shock. The time MSI>1.3, area under the curve, in the first 6h was assessed using logistic regression for primary outcomes of myocardial dysfunction and depression and secondary outcomes including mortality and SOFA score. RESULTS: Overall 578 individuals met inclusion criteria, 169 (29%) developed myocardial dysfunction and 23 (4%) myocardial depression. Adjusted for age, gender, Charlson score, and baseline APACHE 3 score, area MSI>1.3 was associated with increased odds of myocardial dysfunction (OR 1.10, 95% CI 1.00-1.21; p=0.058) and depression (OR 1.28, 95% CI 1.07-1.53; p=0.007). Associations were also seen with ICU mortality (OR 1.17, 95% CI 1.04-1.32; p=0.011), hospital mortality (OR 1.13, 95% CI 1.02-1.25; p=0.025) and SOFA score. CONCLUSION: Elevated modified shock index during early sepsis is associated with the development of myocardial dysfunction and depression, SOFA score and mortality.
PURPOSE: The aim of this study was to explore the association of an elevated modified shock index (MSI) in sepsis and myocardial dysfunction. METHODS: This single center exploratory retrospective cohort study was conducted at Mayo Clinic from 2011 to 2014. It includes adults admitted to the medical intensive care unit with severe sepsis or septic shock. The time MSI>1.3, area under the curve, in the first 6h was assessed using logistic regression for primary outcomes of myocardial dysfunction and depression and secondary outcomes including mortality and SOFA score. RESULTS: Overall 578 individuals met inclusion criteria, 169 (29%) developed myocardial dysfunction and 23 (4%) myocardial depression. Adjusted for age, gender, Charlson score, and baseline APACHE 3 score, area MSI>1.3 was associated with increased odds of myocardial dysfunction (OR 1.10, 95% CI 1.00-1.21; p=0.058) and depression (OR 1.28, 95% CI 1.07-1.53; p=0.007). Associations were also seen with ICU mortality (OR 1.17, 95% CI 1.04-1.32; p=0.011), hospital mortality (OR 1.13, 95% CI 1.02-1.25; p=0.025) and SOFA score. CONCLUSION: Elevated modified shock index during early sepsis is associated with the development of myocardial dysfunction and depression, SOFA score and mortality.