Sepsisli Hastalarda Transfüzyonu Belirlemede Şok İndekslerinin Rolü

Yıl 2021, Cilt: 31 Sayı: 2, 125 - 129, 30.06.2021

Esra Çakır Ahmet Bindal , Pakize Özçiftci Yılmaz , Mehmet Mutlu , Cihangir Doğu , Işıl Özkoçak Turan

https://doi.org/10.15321/GenelTipDer.2021.298

Öz

Amaç: Şok indeksleri özellikle hemorajik şok durumunda transfüzyonu ön görmede kullanılmaktadır. Ancak sepsis hastalarında transfüzyonu belirlemek için şok indekslerinin kullanımı konusunda yeterli çalışma yoktur. Çalışmamızda Yoğun bakım ünitesine (YBÜ) yatan sepsis ve septik şoktaki hastalarda şok indeksi (SI), modifiye şok indeksi (MSI) ve yaş şok indeksinin (YSI) hastaların eritrosit transfüzyonunu ön görmede kullanılabilirliğinin araştırılması amaçlanmıştır.

Gereç ve Yöntem: Çalışmamız Anesteziyoloji ve Yoğun Bakım Ünitesi Kliniğinde 1 Kasım 2017 ile 31 Aralık 2018 tarihleri arasında retrospektif hasta verileri değerlendirilerek yapıldı. Hastaların yaşları, cinsiyetleri, eşlik eden hastalıkları, akut fizyoloji ve kronik sağlık değerlendirme (APACHE II) skoru, mekanik ventilasyon süresi, yatış süresi, hemoglobulin değerleri, SI, MSI, YSI, eritrosit transfüzyon verileri kayıt edildi.

Bulgular: Çalışmaya 225 hasta dahil edildi. Şok indeksi, MSI, YSI düzeyleri eritrosit transfüzyonu gerektiren hastalarda gerektirmeyen hastalara göre istatistiksel olarak anlamlı yüksekti (p<0,05). Şok indeksi için ROC (receiver operating characteristic) eğrisi altındaki alan 0,691'dir (% 95 güven aralığı (GA): 0,626 - 0,751 P = 0,0002). Transfüzyon için SI eşik değeri 0,98’dir (duyarlılık: %86,8, %95 GA: 71,9-95,5, özgüllük: %46,52, %95 GA: 39,2-53,9). MSI için ROC eğrisi altındaki alan 0,666’dır (% 95 GA: 0,601-0,728 P = 0,0012). Transfüzyon için MSI eşik değeri 1,67’dir (duyarlılık: %57,9 %95 GA: 40,8-73,7, özgüllük: %72,7, %95 GA: 65,7-79). Yaş SI için ROC eğrisi altındaki alan 0,639’'dur (% 95 GA: 0,572-0,702 P = 0,0076). Transfüzyon için YSI eşik değeri 102,85’tir (duyarlılık: %39,5, %95 GA: 21,4-56,6, özgüllük: %89,8, %95 GA: 84,6-93,8).

Sonuç: Sepsis hastalarında şok indeksleri transfüzyon ihtiyacını belirlenmede kullanılabilir. Ancak şok indeksleri ile beraber ek parametrelerin kullanılması gerekmektedir.

Anahtar Kelimeler

Eritrosit Transfüzyonu, Yoğun Bakım Ünitesi, Şok İndeksi, Modifiye Şok İndeksi, Yaş Şok İndeksi

The Role of Shock Indices in Determining Transfusion in Patients with Sepsis

Öz

Objective: Shock indices are especially used in hemorragic shocks in order to predict if transfusion is needed or not. But there is not sufficient data for the usage of shock indices in order to predict transfusion needs for septic patients. In this study, we aimed to determine the availibility of shock index (SI), modified shock index (MSI) and age shock index (ASI) for the predicition of transfusion needs in septic and septic shock pateints

Material and Methods: We retrospectively evaluated the results of patients who were hospitalized in ICU, between November 1, 2017 and December 31, 2018. We recorded age, gender, co-morbidities, acute physiology and chronic health evaluation II (APACHE II) scores, length of mechanical ventilation, length of hospital stay, hemoglobin levels, SI, MSI and ASI, erythrocyte transfusion requirement.

Results : We evaluated 225 patients. SI, MSI and ASI levels were significantly higher in patients requiring erythrocyte transfusion compared with patients not receiving transfusion (p < 0.05). For SI, the area under the receiver operating characteristic (ROC) curve was 0.691 (95% confidence interval (CI): 0.626–0.751, p = 0.0002) and cutoff value for transfusion was 0.98 (sensitivity: 86.8%, 95% CI: 71.9-95.5; specificity: 46.52%, 95% CI: 39..2-53.9). For MSI, the area under the ROC curve was 0.666 (95% CI: 0.601–0.728, p = 0.0012) and cutoff value for transfusion was 1.67 (sensitivity: 57.9%, 95% CI: 40.8-73.7; specificity: 72.7%, 95% CI: 65.7-79). For ASI, the area under the ROC curve was 0.639 (95% CI: 0.572–0.702, p = 0.0076) and cutoff value for transfusion was 102.85 (sensitivity: 39.5%, 95% CI: 21.4–56.6; specificity: 89.8%, 95% CI: 84.6–93.8).

Discussion: Shock indices can be used in septic pateints in order to predict their erytocyte transfusion needs. Additional parameters are needed to be used together with septic indices.

Anahtar Kelimeler

Erythrocyte Transfusion, Intensive Care Unit, Shock Index, Modified Shock Index, Age Shock Index

Kaynakça

• Berger T, Green J, Horeczko T, et al. Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med 2013;14:168-74.
• Yussof SJ, Zakaria MI, Mohamed FL, Bujang MA, Lakshmanan S, Asaari AH. Value of Shock Index in prognosticating the short-term outcome of death for patients presenting with severe sepsis and septic shock in the emergency department. Med J Malaysia 2012;67:406-11.
• Armstrong BA, Betzold RD, May AK. Sepsis and Septic Shock Strategies. Surg Clin North Am 2017;97:1339-1379.
• Nathan HL, Seed PT, Hezelgrave NL, et al. Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study. Acta Obstet Gynecol Scand 2019;98:1178-1186.
• El-Menyar A, Abdelrahman H, Alhammoud A, et al. Prognostic Role of Shock Index in Traumatic Pelvic Fracture: A Retrospective Analysis. J Surg Res 2019;243:410-418.
• Strutt J, Flood A, Kharbanda AB. Shock Index as a Predictor of Morbidity and Mortality in Pediatric Trauma Patients. Pediatr Emerg Care 2019;35:132-137.
• Schroll R, Swift D, Tatum D, et al. Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients. Injury 2018;49:15-19.
• Day DL, Anzelon KM, Conde FA. Association of Prehospital Shock Index and Trauma Bay Uncrossmatched Red Blood Cell Transfusion With Multiple Transfusion. J Trauma Nurs 2016;23:89-95.
• Mutschler M, Nienaber U, Münzberg M, et al. The Shock Index revisited - a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU. Crit Care 2013;17:R172.
• Liu YC, Liu JH, Fang ZA, et al. Modified shock index and mortality rate of emergency patients. World J Emerg Med 2012;3:114-7.
• Singh A, Ali S, Agarwal A, Srivastava RN. Correlation of shock index and modified shock index with the outcome of adult trauma patients: a prospective study of 9860 patients. N Am J Med Sci 2014;6:450-2.
• Wang IJ, Bae BK, Park SW, et al. Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients. Am J Emerg Med 2019. pii: S0735-6757(19)30034-8.
• Sharma A, Naga Satish U, Tevatia MS, Singh SK. Prehospital shock index, modified shock index, and pulse pressure heart rate ratio as predictors of massive blood transfusions in modern warfare injuries: A retrospective analysis. Med J Armed Forces India 2019;75:171-175.
• Torabi M, Moeinaddini S, Mirafzal A, Rastegari A, Sadeghkhani N. Shock index, modified shock index, and age shock index for prediction of mortality in Emergency Severity Index level 3. Am J Emerg Med 2016;34:2079-2083.
• Rau CS, Wu SC, Kuo SC, et al. Prediction of Massive Transfusion in Trauma Patients with Shock Index, Modified Shock Index, and Age Shock Index. Int J Environ Res Public Health 2016;13.
• Jansma G, de Lange F, Kingma WP, et al. 'Sepsis-related anemia' is absent at hospital presentation; a retrospective cohort analysis. BMC Anesthesiol 2015;15:55.
• Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.
• Lilly CM, Badawi O, Liu X, Christine S G, Harris I. Red Blood Cell Product Transfusion Thresholds and Clinical Outcomes. J Intensive Care Med 2018:885066618762746.
• Rygård SL, Holst LB, Perner A. Blood Product Administration in the Critical Care and Perioperative Settings. Crit Care Clin. 2018;34:299-311.
• Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med 1994;24:685-90.
• Kohn JR, Dildy GA, Eppes CS. Shock index and delta-shock index are superior to existing maternal early warning criteria to identify postpartum hemorrhage and need for intervention. J Matern Fetal Neonatal Med 2019;32:1238-1244.
• Maneschi F, Perrone S, Di Lucia A, Ianiri P. Shock parameters and shock index during severe post-partum haemorrhage and implications for management: a clinical study. J Obstet Gynaecol 2019:1-6.
• Lee SY, Kim HY, Cho GJ, Hong SC, Oh MJ, Kim HJ. Use of the shock index to predict maternal outcomes in women referred for postpartum hemorrhage. Int J Gynaecol Obstet 2019;144:221-224.
• Vandromme MJ, Griffin RL, Kerby JD, McGwin G Jr, Rue LW, Weinberg JA. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma 2011;70:384-8.
• Wu SC, Rau CS, Kuo SCH, Hsu SY, Hsieh HY, Hsieh CH. Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis. PLoS One 2019;14:e0216153.
• McKinley TO, McCarroll T, Gaski GE, et al. Shock Volume: A Patient-Specific Index That Predicts Transfusion Requirements and Organ Dysfunction in Multiply Injured Patients. Shock 2016;45:126-32.
• El-Menyar A, Goyal P, Tilley E, Latifi R. The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma. J Surg Res 2018;227:52-59.
• Pacagnella RC, Souza JP, Durocher J, et al. A systematic review of the relationship between blood loss and clinical signs. PLoS One 2013;8:e57594.
• Singh A, Ali S, Agarwal A, Srivastava RN. Correlation of shock index and modified shock index with the outcome of adult trauma patients: a prospective study of 9860 patients. N Am J Med Sci 2014;6:450-2.
• Zarzaur BL, Croce MA, Fischer PE, Magnotti LJ, Fabian TC. New vitals after injury: shock index for the young and age x shock index for the old. J Surg Res 2008;147:229-36.