Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients.
Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients.
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DOI：
10.1097/ta.0000000000001871
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发表时间：
2018-07
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影响因子：
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通讯作者：
Gaski GE
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文献类型：
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作者：
McKinley TO;McCarroll T;Metzger C;Zarzaur BL;Savage SA;Bell TM;Gaski GE
多次受伤的病人有发生失血性休克和器官功能障碍的危险。我们通过整合一系列休克指数测量来确定累积灌注不足如何预测器官功能障碍。在这项研究中，我们计算了休克量（SHVL），这是一个患者特有的指标，通过整合损伤后急性异常升高的休克指数（心率/收缩压≥0.9）值来量化累积灌注不足。分别在损伤后3小时（3小时）、6小时（6小时）和24小时（24小时）计算休克量。使用Marshall器官功能障碍评分（aMODSD2-D5）对损伤后第2 - 5天的器官功能障碍进行量化。采用Logistic回归分析3hrSHVL、6hrSHVL、24hrSHVL与器官功能障碍的对应关系。我们将SHVL与器官功能障碍的对应关系与传统的休克指标进行了比较，包括初始碱基缺陷（BD）和损伤后24小时内的最低pH值（最低pH值）。与初始BD （R2 = 0.32）和最小pH值（R2 = 0.32）相比，三个时间间隔的SHVL与器官功能障碍的相关性更高（R2 = 0.48至0.52）。此外，我们比较了SHVL、初始BD和最小pH值的预测能力，通过构建受体操作者特征曲线来识别有发生高强度器官功能障碍风险的患者。与初始BD和最小ph值相比，6小时和24小时的SHVL曲线下面积更高。SHVL是一种无创指标，可以预测预期的器官功能障碍，并识别损伤后存在高强度器官功能障碍风险的患者。预后研究，III级。
Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial Shock Index measurements. In this study, we calculated shock volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated Shock Index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury. Shock volume was calculated at three hours (3 hr), six hours (6 hr), and twenty-four hours (24 hr) after injury. Organ dysfunction was quantified using Marshall Organ Dysfunction Scores averaged from days 2 through 5 after injury (aMODSD2–D5). Logistic regression was used to determine correspondence of 3hrSHVL, 6hrSHVL, and 24hrSHVL to organ dysfunction. We compared correspondence of SHVL to organ dysfunction with traditional indices of shock including the initial base deficit (BD) and the lowest pH measurement made in the first 24 hr after injury (minimum pH). SHVL at all three time intervals demonstrated higher correspondence to organ dysfunction (R2 = 0.48 to 0.52) compared to initial BD (R2 = 0.32) and minimum pH (R2 = 0.32). Additionally, we compared predictive capabilities of SHVL, initial BD and minimum pH to identify patients at risk of developing high-magnitude organ dysfunction by constructing receiver operator characteristic curves. SHVL at six hours and 24 hours had higher area under the curve compared to initial BD and minimum pH. SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high-magnitude organ dysfunction after injury. Prognostic study, level III.