The shock index predicts acute mortality outcomes in stroke

Stephen J McCall, Stanley D Musgrave, John F Potter, Rachel Hale, Allan B Clark, Mamas A Mamas, Anthony K Metcalf, Diana J Day, Elizabeth A Warburton, Max O Bachmann, Phyo K Myint, On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

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Abstract

BACKGROUND: Shock index (SI) (ratio between heart rate and systolic blood pressure) has been shown to be associated with poor mortality outcomes in trauma and pneumonia; however it has yet to be examined in stroke. We aimed to examine the relationship between SI and acute outcomes of inpatient, 3-day and 7-day mortality in stroke. Secondly, we aimed to compare SI and systolic blood pressure (SBP) alone in predicting above outcomes.

METHODS: Data from a multicentre prospective cohort study conducted between October 2009 and September 2012 in eight NHS trusts in East of England were analysed. The relationships between SI, SBP and study outcomes were assessed using multivariable logistic regression models using mid-quintile groups as the reference category. Receiver operating characteristic (ROC) curves assessed the discriminating ability between the SI and SBP models.

RESULTS: A total of 2121 stroke patients were included (47.4% men; mean age 77.10 (sd) 12.40) years. The lowest quintile of the SI, had an increased odds of 3-day and 7-day mortality, adjusted odds ratio (AOR) 2.45 (95% CI:1.16-5.17) and 1.88 (1.01-3.49), respectively. Patients with the highest quintile of SI also had increased odds of in-patient, 3-day and 7-day mortality, AORs 1.85 (1.17-2.92), 2.18 (1.03-4.63) and 2.45 (1.34-4.49), respectively. Similarly, SBP had a U-shape relationship with mortality. All measures had an ROC area under the curve >0.8 but there was no difference in the discriminating ability between SI and SBP.

CONCLUSIONS: SI at extremely high and low values appeared to predict stroke mortality and appears to be particularly useful in predicting very early (3-day) mortality.

Original languageEnglish
Pages (from-to)523-527
Number of pages5
JournalInternational Journal of Cardiology
Volume182
Early online date3 Jan 2015
DOIs
Publication statusPublished - 1 Mar 2015

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Shock
Stroke
Blood Pressure
Mortality
ROC Curve
Logistic Models
England
Area Under Curve
Inpatients
Pneumonia
Cohort Studies
Heart Rate
Odds Ratio
Outcome Assessment (Health Care)
Prospective Studies
Wounds and Injuries

Keywords

  • shock index
  • prognosis
  • stroke mortality
  • acute
  • systolic blood pressure

Cite this

McCall, S. J., Musgrave, S. D., Potter, J. F., Hale, R., Clark, A. B., Mamas, M. A., ... On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group (2015). The shock index predicts acute mortality outcomes in stroke. International Journal of Cardiology, 182, 523-527. https://doi.org/10.1016/j.ijcard.2014.12.175

The shock index predicts acute mortality outcomes in stroke. / McCall, Stephen J; Musgrave, Stanley D; Potter, John F; Hale, Rachel; Clark, Allan B; Mamas, Mamas A; Metcalf, Anthony K; Day, Diana J; Warburton, Elizabeth A; Bachmann, Max O; Myint, Phyo K; On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group.

In: International Journal of Cardiology, Vol. 182, 01.03.2015, p. 523-527.

Research output: Contribution to journalArticle

McCall, SJ, Musgrave, SD, Potter, JF, Hale, R, Clark, AB, Mamas, MA, Metcalf, AK, Day, DJ, Warburton, EA, Bachmann, MO, Myint, PK & On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group 2015, 'The shock index predicts acute mortality outcomes in stroke' International Journal of Cardiology, vol. 182, pp. 523-527. https://doi.org/10.1016/j.ijcard.2014.12.175
McCall SJ, Musgrave SD, Potter JF, Hale R, Clark AB, Mamas MA et al. The shock index predicts acute mortality outcomes in stroke. International Journal of Cardiology. 2015 Mar 1;182:523-527. https://doi.org/10.1016/j.ijcard.2014.12.175
McCall, Stephen J ; Musgrave, Stanley D ; Potter, John F ; Hale, Rachel ; Clark, Allan B ; Mamas, Mamas A ; Metcalf, Anthony K ; Day, Diana J ; Warburton, Elizabeth A ; Bachmann, Max O ; Myint, Phyo K ; On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group. / The shock index predicts acute mortality outcomes in stroke. In: International Journal of Cardiology. 2015 ; Vol. 182. pp. 523-527.
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AU - Musgrave, Stanley D

AU - Potter, John F

AU - Hale, Rachel

AU - Clark, Allan B

AU - Mamas, Mamas A

AU - Metcalf, Anthony K

AU - Day, Diana J

AU - Warburton, Elizabeth A

AU - Bachmann, Max O

AU - Myint, Phyo K

AU - On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. Acknowledgements We gratefully acknowledge the funder of this research, NIHR Re-search for Patient Benefit Programme. We are also indebted to all there-search and clinical teams based at the participating NHS Trusts, and the staff from the respective Research & Development Departments. We also would like to thank the Anglia Stroke & Heart Clinical Network for their support

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N2 - BACKGROUND: Shock index (SI) (ratio between heart rate and systolic blood pressure) has been shown to be associated with poor mortality outcomes in trauma and pneumonia; however it has yet to be examined in stroke. We aimed to examine the relationship between SI and acute outcomes of inpatient, 3-day and 7-day mortality in stroke. Secondly, we aimed to compare SI and systolic blood pressure (SBP) alone in predicting above outcomes.METHODS: Data from a multicentre prospective cohort study conducted between October 2009 and September 2012 in eight NHS trusts in East of England were analysed. The relationships between SI, SBP and study outcomes were assessed using multivariable logistic regression models using mid-quintile groups as the reference category. Receiver operating characteristic (ROC) curves assessed the discriminating ability between the SI and SBP models.RESULTS: A total of 2121 stroke patients were included (47.4% men; mean age 77.10 (sd) 12.40) years. The lowest quintile of the SI, had an increased odds of 3-day and 7-day mortality, adjusted odds ratio (AOR) 2.45 (95% CI:1.16-5.17) and 1.88 (1.01-3.49), respectively. Patients with the highest quintile of SI also had increased odds of in-patient, 3-day and 7-day mortality, AORs 1.85 (1.17-2.92), 2.18 (1.03-4.63) and 2.45 (1.34-4.49), respectively. Similarly, SBP had a U-shape relationship with mortality. All measures had an ROC area under the curve >0.8 but there was no difference in the discriminating ability between SI and SBP.CONCLUSIONS: SI at extremely high and low values appeared to predict stroke mortality and appears to be particularly useful in predicting very early (3-day) mortality.

AB - BACKGROUND: Shock index (SI) (ratio between heart rate and systolic blood pressure) has been shown to be associated with poor mortality outcomes in trauma and pneumonia; however it has yet to be examined in stroke. We aimed to examine the relationship between SI and acute outcomes of inpatient, 3-day and 7-day mortality in stroke. Secondly, we aimed to compare SI and systolic blood pressure (SBP) alone in predicting above outcomes.METHODS: Data from a multicentre prospective cohort study conducted between October 2009 and September 2012 in eight NHS trusts in East of England were analysed. The relationships between SI, SBP and study outcomes were assessed using multivariable logistic regression models using mid-quintile groups as the reference category. Receiver operating characteristic (ROC) curves assessed the discriminating ability between the SI and SBP models.RESULTS: A total of 2121 stroke patients were included (47.4% men; mean age 77.10 (sd) 12.40) years. The lowest quintile of the SI, had an increased odds of 3-day and 7-day mortality, adjusted odds ratio (AOR) 2.45 (95% CI:1.16-5.17) and 1.88 (1.01-3.49), respectively. Patients with the highest quintile of SI also had increased odds of in-patient, 3-day and 7-day mortality, AORs 1.85 (1.17-2.92), 2.18 (1.03-4.63) and 2.45 (1.34-4.49), respectively. Similarly, SBP had a U-shape relationship with mortality. All measures had an ROC area under the curve >0.8 but there was no difference in the discriminating ability between SI and SBP.CONCLUSIONS: SI at extremely high and low values appeared to predict stroke mortality and appears to be particularly useful in predicting very early (3-day) mortality.

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JO - International Journal of Cardiology

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