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
ARTICLE HIGHLIGHTS
Research background

Patients who suffer severe head trauma are also affected by altered balance between heart rate (HR) 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.

Research motivation

To the best of our knowledge, there are no studies that assess the role of SI and its variants as a predictor tool of mortality in severe TBI (sTBI) patients without multiple central injuries. The findings of this study can guide future clinical procedures to ensure a positive impact on the prognosis and quality of life of this population.

Research objectives

This study aims to describe the predictive potential of SI and its variants as an outcome-predictive tool in sTBI patients.

Research methods

This was a prospective observational study conducted at the Pronto-Socorro Hospital, a trauma reference center at Porto Alegre, RS, Brazil, including 71 patients were included in this study. The study included retrospective data, covering the period from January 2019 to December 2022. The collected variables were: Glasgow Coma Scale (GCS) score, injury description, age, sex, days of fasting, body mass, estimated height, blood pressure, and HR parameters. Body mass index (BMI = body mass/Height2) was calculated to classify the patients according to the criteria of the World Health Organization. The SI, reverse SI (rSI), and rSI multiplied by the Glasgow Coma Score (rSIG) were calculated as the ratio of HR to systolic blood pressure (SBP) (SI = HR/SBP), ratio of SBP to HR (rSI = SBP/HR), the score of rSI × GCS, and age multiplied SI (AgeSI = Age × SI) respectively. 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.

Research results

No significant differences between groups were identified for SI, rSI, or rSIG. The AgeSI was significantly higher in non-survival (NS) patients at 48 h following admission (Survival: 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. For AgeSI at 48 h, the AUROC curve for predicting mortality was 0.727.

Research conclusions

Patients who suffer severe head trauma are also affected by altered balance between HR and blood pressure which influences oxygen delivery to tissues and the overall cardiac function. Although previous studies indicated that SI and its variants could predict the outcomes following TBI the studies were conducted in patients with different severities of injury. Therefore, when evaluating patients who suffered a 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 AgeSI was a viable outcome-predictive tool in sTBI, warranting future research in different cohorts.

Research perspectives

Future studies should evaluate the AgeSI as an outcome-predictive tool in sTBI.