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

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Abstract

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.
Original languageEnglish
Article numbere007581
Number of pages12
JournalJournal of the American Heart Association
Volume7
Issue number18
Early online date7 Sep 2018
DOIs
Publication statusPublished - 18 Sep 2018

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Shock
Stroke
National Institutes of Health (U.S.)
Confidence Intervals
Blood Pressure
Length of Stay
Point-of-Care Systems
Mortality
Cerebral Hemorrhage
Hospital Mortality
Linear Models
Heart Rate
Odds Ratio

Keywords

  • length of stay
  • prognosis
  • mortality
  • shock index

Cite this

Myint, P. K., Sheng, S., Xian, Y., Matsouaka, R. A., Reeves, M. J., Saver, J. L., ... Smith, E. E. (2018). Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke. Journal of the American Heart Association, 7(18), [e007581]. https://doi.org/10.1161/JAHA.117.007581

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke. / Myint, Phyo Kyaw (Corresponding Author); 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.

In: Journal of the American Heart Association, Vol. 7, No. 18, e007581, 18.09.2018.

Research output: Contribution to journalArticle

Myint, PK, Sheng, S, Xian, Y, Matsouaka, RA, Reeves, MJ, Saver, JL, Bhatt, DL, Fonarow, GC, Schwamm, LH & Smith, EE 2018, 'Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke', Journal of the American Heart Association, vol. 7, no. 18, e007581. https://doi.org/10.1161/JAHA.117.007581
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. / Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 18.
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title = "Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke",
abstract = "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.",
keywords = "length of stay, prognosis, mortality, shock index",
author = "Myint, {Phyo Kyaw} and Shubin Sheng and Ying Xian and Matsouaka, {Roland A} and Reeves, {Mathew J} and Saver, {Jeffrey L} and Bhatt, {Deepak L} and Fonarow, {Gregg C.} and Schwamm, {Lee H} and Smith, {Eric E}",
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.",
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T1 - Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

AU - Myint, Phyo Kyaw

AU - Sheng, Shubin

AU - Xian, Ying

AU - Matsouaka, Roland A

AU - Reeves, Mathew J

AU - Saver, Jeffrey L

AU - Bhatt, Deepak L

AU - Fonarow, Gregg C.

AU - Schwamm, Lee H

AU - Smith, Eric E

N1 - 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.

PY - 2018/9/18

Y1 - 2018/9/18

N2 - 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.

AB - 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.

KW - length of stay

KW - prognosis

KW - mortality

KW - shock index

U2 - 10.1161/JAHA.117.007581

DO - 10.1161/JAHA.117.007581

M3 - Article

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 18

M1 - e007581

ER -