OBJECTIVE: We evaluated the performance of diastolic shock index (DSI) and lactate in predicting vasopressor requirement among hypotensive patients with suspected infection in an emergency department. METHODS: This was a single-center, retrospective observational study for adult patients with suspected infection and hypotension in the emergency department from 2018 to 2019. The study population was split into derivation and validation cohorts (70/30). We derived a simple risk score to predict vasopressor requirement using DSI and lactate cutoff values determined by Youden index. We tested the score by the area under the receiver operating characteristic curve (AUC). We performed a multivariable regression analysis to evaluate the association between the timing of vasopressor treatment and 28-day mortality. RESULTS: A total of 1,917 patients were included. We developed a score, assigning 1 point each for the high DSI (≥2.0) and high lactate (≥2.5 mmol/L) criteria. The AUCs of the score were 0.741 (95% confidence interval [CI], 0.715-0.768) at hypotension and 0.736 (95% CI, 0.708-0.763) after initial fluid challenge in the derivation cohort and 0.676 (95% CI, 0.631-0.719) at hypotension and 0.688 (95% CI, 0.642-0.733) after initial fluid challenge in the validation cohort, respectively. In patients with scores of 2 points, early vasopressor therapy initiation was significantly associated with decreased 28-day mortality (adjusted odds ratio, 0.37; 95% CI, 0.14-0.94). CONCLUSION: A prediction model with DSI and lactate levels might be useful to identify patients who are more likely to need vasopressor administration among hypotensive patients with suspected infection.
OBJECTIVE: We evaluated the performance of diastolic shock index (DSI) and lactate in predicting vasopressor requirement among hypotensive patients with suspected infection in an emergency department. METHODS: This was a single-center, retrospective observational study for adult patients with suspected infection and hypotension in the emergency department from 2018 to 2019. The study population was split into derivation and validation cohorts (70/30). We derived a simple risk score to predict vasopressor requirement using DSI and lactate cutoff values determined by Youden index. We tested the score by the area under the receiver operating characteristic curve (AUC). We performed a multivariable regression analysis to evaluate the association between the timing of vasopressor treatment and 28-day mortality. RESULTS: A total of 1,917 patients were included. We developed a score, assigning 1 point each for the high DSI (≥2.0) and high lactate (≥2.5 mmol/L) criteria. The AUCs of the score were 0.741 (95% confidence interval [CI], 0.715-0.768) at hypotension and 0.736 (95% CI, 0.708-0.763) after initial fluid challenge in the derivation cohort and 0.676 (95% CI, 0.631-0.719) at hypotension and 0.688 (95% CI, 0.642-0.733) after initial fluid challenge in the validation cohort, respectively. In patients with scores of 2 points, early vasopressor therapy initiation was significantly associated with decreased 28-day mortality (adjusted odds ratio, 0.37; 95% CI, 0.14-0.94). CONCLUSION: A prediction model with DSI and lactate levels might be useful to identify patients who are more likely to need vasopressor administration among hypotensive patients with suspected infection.
Authors: Mervyn Singer; Clifford S Deutschman; Christopher Warren Seymour; Manu Shankar-Hari; Djillali Annane; Michael Bauer; Rinaldo Bellomo; Gordon R Bernard; Jean-Daniel Chiche; Craig M Coopersmith; Richard S Hotchkiss; Mitchell M Levy; John C Marshall; Greg S Martin; Steven M Opal; Gordon D Rubenfeld; Tom van der Poll; Jean-Louis Vincent; Derek C Angus Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: Chairat Permpikul; Surat Tongyoo; Tanuwong Viarasilpa; Thavinee Trainarongsakul; Tipa Chakorn; Suthipol Udompanturak Journal: Am J Respir Crit Care Med Date: 2019-05-01 Impact factor: 21.405
Authors: Gustavo A Ospina-Tascón; Glenn Hernandez; Ingrid Alvarez; Luis E Calderón-Tapia; Ramiro Manzano-Nunez; Alvaro I Sánchez-Ortiz; Egardo Quiñones; Juan E Ruiz-Yucuma; José L Aldana; Jean-Louis Teboul; Alexandre Biasi Cavalcanti; Daniel De Backer; Jan Bakker Journal: Crit Care Date: 2020-02-14 Impact factor: 9.097
Authors: Vance Beck; Dan Chateau; Gregory L Bryson; Amarnath Pisipati; Sergio Zanotti; Joseph E Parrillo; Anand Kumar Journal: Crit Care Date: 2014-05-12 Impact factor: 9.097