Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2024; 13(1): 90617
Published online Mar 9, 2024. doi: 10.5492/wjccm.v13.i1.90617
Shock index and its variants as predictors of mortality in severe traumatic brain injury
Randhall B Carteri, Mateus Padilha, Silvaine Sasso de Quadros, Eder Kroeff Cardoso, Mateus Grellert
Randhall B Carteri, Department of Nutrition, Centro Universitário CESUCA, Porto Alegre 94935-630, Brazil
Mateus Padilha, Department of Analysis and Systems Development, Centro Universitário CESUCA, Porto Alegre 94935-630, Brazil
Silvaine Sasso de Quadros, Department of Nutrition, Hospital Pronto Socorro de Porto Alegre, Porto Alegre 90040-192, Rio Grande do Sul, Brazil
Eder Kroeff Cardoso, Department of Physiotherapy, Hospital Pronto Socorro de Porto Alegre, Porto Alegre 90040-192, Rio Grande do Sul, Brazil
Mateus Grellert, Institute of Informatics, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 91501-970, Rio Grande do Sul, Brazil
Author contributions: Carteri RB was responsible for concept and design, data collection, statistical analysis, and manuscript writing; Padilha M was responsible for data collection, statistical analysis, and manuscript writing; de Quadros SS and Kroeff E were responsible for data collection, manuscript writing, and key revisions; Grellert M was responsible for the concept and design, statistical analysis, manuscript writing and critical editing.
Institutional review board statement: This project was approved by the Research Ethics Committee of Hospital Pronto Socorro de Porto Alegre (number CEP SMSPA; registration number: 3.912.623).
Informed consent statement: The informed consent form has been waived.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest related to this article.
Data sharing statement: No additional data is available for sharing.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Randhall B Carteri, PhD, Postdoc, Professor, Researcher, Department of Nutrition, Centro Universitário CESUCA, Silvério Manoel da Silva, 160-Colinas, Cachoeirinha-RS, Porto Alegre 94935-630, Brazil. rcarteri@outlook.com
Received: December 8, 2023
Peer-review started: December 8, 2023
First decision: December 19, 2023
Revised: December 28, 2023
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: March 9, 2024
Processing time: 87 Days and 8.7 Hours
Abstract
BACKGROUND

The increase in severe traumatic brain injury (sTBI) incidence is a worldwide phenomenon, resulting in a heavy disease burden in the public health systems, specifically in emerging countries. The shock index (SI) is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock, which is increased in sTBI. Considering the high mortality of sTBI, scrutinizing the predictive potential of SI and its variants is vital.

AIM

To describe the predictive potential of SI and its variants in sTBI.

METHODS

This study included 71 patients (61 men and 10 women) divided into two groups: Survival (S; n = 49) and Non-survival (NS; n = 22). The responses of blood pressure and heart rate (HR) were collected at admission and 48 h after admission. The SI, reverse SI (rSI), rSI multiplied by the Glasgow Coma Score (rSIG), and Age multiplied SI (AgeSI) were calculated. Group comparisons included Shapiro-Wilk tests, and independent samples t-tests. For predictive analysis, logistic regression, receiver operator curves (ROC) curves, and area under the curve (AUC) measurements were performed.

RESULTS

No significant differences between groups were identified for SI, rSI, or rSIG. The AgeSI was significantly higher in NS patients at 48 h following admission (S: 26.32 ± 14.2, and NS: 37.27 ± 17.8; P = 0.016). Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.

CONCLUSION

Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function, only the AgeSI was a viable outcome-predictive tool in sTBI, warranting future research in different cohorts.

Keywords: Head trauma, Critical patient, Neuro-cardio axis, Predictive tool, Clinical practice

Core Tip: Patients who suffer severe head trauma are also affected by altered balance between heart rate and blood pressure which influences oxygen delivery to tissues and the overall cardiac function. Although previous studies indicated that shock index (SI) and its variants could predict the outcomes following traumatic brain injury (TBI) the studies were conducted in patients with different severities of injury. Therefore, when evaluating patients who suffered a severe TBI (sTBI), the SI and its variants are not a viable outcome-predictive tool in sTBI, due to similar responses in both surviving and non-surviving patients. However, the Age multiplied SI was a viable outcome-predictive tool in sTBI, warranting future research in different cohorts.