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Shock index predicted mortality in geriatric patients with influenza in the emergency department

  • Author Footnotes
    1 These authors contribute equally.
    Jui-Yuan Chung
    Footnotes
    1 These authors contribute equally.
    Affiliations
    Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
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  • Author Footnotes
    1 These authors contribute equally.
    Chien-Chin Hsu
    Footnotes
    1 These authors contribute equally.
    Affiliations
    Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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  • Jiann-Hwa Chen
    Affiliations
    Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan

    Fu Jen Catholic University School of Medicine, Taipei, Taiwan
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  • Wei-Lung Chen
    Affiliations
    Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan

    Fu Jen Catholic University School of Medicine, Taipei, Taiwan
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  • Hung-Jung Lin
    Affiliations
    Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
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  • How-Ran Guo
    Correspondence
    Correspondence to: H.-R. Guo, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, East District, Tainan City 701, Taiwan.
    Affiliations
    Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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  • Chien-Cheng Huang
    Correspondence
    Correspondence to: C.-C. Huang, Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
    Affiliations
    Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

    Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
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  • Author Footnotes
    1 These authors contribute equally.

      Abstract

      Background

      The shock index is a rapid and simple tool used to predict mortality in patients with acute illnesses including sepsis, multiple trauma, and postpartum hemorrhage. However, its ability to predict mortality in geriatric patients with influenza in the emergency department (ED) remains unclear. This study was conducted to clarify this issue.

      Methods

      We conducted a retrospective case-control study, recruiting geriatric patients (≥ 65 years) with influenza visiting the ED of a medical center between January 01, 2010 and December 31, 2015. Demographic data, vital signs, shock index, past histories, subtypes of influenza, and outcomes were included for the analysis. We investigated the association between shock index ≥1 and 30-day mortality.

      Results

      In total, 409 geriatric ED patients with mean age of 79.5 years and nearly equal sex ratio were recruited. The mean shock index ± standard deviation was 0.7 ± 0.22 and shock index ≥1 was accounted for in 7.1% of the total patients. Logistic regression showed that shock index ≥1 predicted mortality (odds ratio: 6.80; 95% confidence interval: 2.39–19.39). The area under the receiver operating characteristic was 0.62 and the result of the Hosmer–Lemeshow goodness-of-fit test was 0.23. The sensitivity, specificity, positive predictive value, and negative predictive value of a shock index ≥1 were 30.0%, 94.1%, 20.0%, and 96.4%.

      Conclusions

      A shock index ≥1 has a high specificity, negative predictive value, and good reliability to predict 30-day mortality in geriatric ED patients with influenza.

      Keywords

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