Diastolic Shock Index to Predict Progression into Septic Shock

In septic shock, hypotension is primarily caused by the failure of vascular smooth muscle to constrict, leading to systemic vasodilation and eventual diastolic dysfunction. Therefore, the diastolic shock index (DSI) may be a more appropriate measure than mean arterial pressure (MAP) or systolic shock index (SI) for quantifying the severity of septic shock. A DSI of 2.0 or greater has been associated with increased mortality and demonstrates superior predictive value compared to heart rate (HR) and systolic SI alone. The DSI is calculated as: DSI = HR / DBP. Its early calculation can predict progression to septic shock before hemodynamic instability manifests, thereby enabling clinicians to initiate prompt treatment for sepsis and potentially avert overt shock. Furthermore, DSI may also serve as a valuable predictor of mortality in patients with sepsis.