Temporal Analysis of Diastolic Shock Index in Patients with Septic Shock and its Correlation with Clinical Outcomes in Indian Setting – A Prospective Observational Study

INTRODUCTION: Sepsis is a multifaceted syndrome in patients with suspected infection, characterized by cluster of clinical signs and symptoms. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Diastolic shock index (DSI), represent a simple ratio between DAP and heart rate (HR), has been implicated as a surrogate to the state of the vascular tone. In 2020, a study done by Ospina tascón et al concluded that DSI can serve as an early indicator of high mortality risk in septic shock patients. Prospective studies regarding DSI and its correlation to clinical outcomes are lacking. OBJECTIVES: We analyzed the temporal trends of DSI in septic shock patients and correlated these trends with mortality outcomes. Also calculated the Shock Index, Diastolic Shock Index, Modified Shock Index at different time points and did a comparative analysis of these indices and to evaluate their prognostic performance in predicting clinical outcomes. MATERIALS AND METHODS: In this prospective, single-centre observational study, ICU patients >18 years with septic shock (Sepsis-3 criteria) were included. Data on demographics, clinical parameters, severity scores, and outcomes were collected. DSI, Shock Index (SI), and Modified Shock Index (MSI) were calculated at shock onset and 24 hours later. Statistical analyses, including ROC curves, were performed using SPSS-23. RESULTS: Of 52 patients admitted, 32 septic shock patients (Age mean ± SD 43.84 ± 19.45); 62.5% males) were included. They were grouped as survivors (n=20) and non-survivors (n=12) at end of ICU Day 28. Median (IQR) APACHE score at admission, SOFA scores at inclusion were 21.5 (13.25-26) and 9 (7-12) respectively. In survivors, mean ± SD, at onset were: DSI (1.90 ± 0.54), SI (1.15 ± 0.32), MSI (1.54 ± 0.38); and after 24 hours: DSI (1.57 ± 0.41), SI (0.91 ± 0.31), MSI (1.24 ± 0.33). ROC analysis showed SI and MSI trends were better survival predictors than DSI trends. DISCUSSIONS/CONCLUSIONS: Despite a higher hemodynamic indices at onset of shock in survivor group, the increasing trend of these indices were observed in non-survivor group. ROC curve analysis revealed shock index trend and modified shock index trend were significant in predicting survival than Diastolic shock index trend after 24hrs of onset of septic shock. These findings suggest that rather than the DSI at onset, it is the monitoring of DSI trends over next 24hours can guide early risk stratification and management in septic shock patients.