Shock Volume: Patient-Specific Cumulative Hypoperfusion Predicts Organ Dysfunction in a Prospective Cohort of Multiply Injured Patients

AbstractBackgroundMultiply 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.MethodsIn 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 (3hr), six hours (6hr), and twenty-four hours (24hr) 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 24hr after injury (minimum pH).ResultsSHVL 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.ConclusionsSHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high magnitude organ dysfunction after injury.Level of EvidencePrognostic study with Level of Evidence: III Background 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. Methods 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 (3hr), six hours (6hr), and twenty-four hours (24hr) 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 24hr after injury (minimum pH). Results 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. Conclusions SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high magnitude organ dysfunction after injury. Level of Evidence Prognostic study with Level of Evidence: III None of the authors has a conflict of interest or extramural funding for this research. This material was presented in its entirety at the MHSRS 2017 August 27th -30th, Orlando, FL. © 2018 Lippincott Williams & Wilkins, Inc.

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