The Respiratory Adjusted Shock Index at Admission Is a Valuable Predictor of In-Hospital Outcomes for Elderly Emergency Patients with Medical Diseases at a Japanese Community General Hospital
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Participants, and Ethics Statement
2.2. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Association of RASI with Lactate, NEWS2, SI, ΔSOFA Score, qSOFA Score, and SIRS Criteria
3.3. Comparison of RASI between Individuals Who Died within 7 or 30 Days and Those Who Survived
3.4. Predictive Capacity of RASI and Other Clinical Indices for Death within 7 and 30 Days
3.5. Predictive Capacity of RASI for Death within 7 and 30 Days Compared between Patients on and off Anti-Hypertensive Drugs
3.6. Comparison of Indices Including the RASI and the Predictive Capacities of the RASI for Mortality within 7 or 30 Days with and without Prehospital Administration
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total Subjects (n = 260) | |
---|---|
Age (years) | 86 (81–92) |
Male (n, (%)) | 126 (48.5) |
Admission (n, (%)) | 234 (90.0) |
Prehospital oxygen administration (n, (%)) | 160 (61.5) |
Death within 7 days of admission (n, (%)) | 27 (10.4) |
Death within 30 days of admission (n, (%)) | 49 (18.8) |
Diseases that led to emergency transport (n, (%)) | |
Diseases of the respiratory system | 98 (37.7) |
Diseases of the circulatory system | 64 (24.6) |
Diseases of the digestive system | 27 (10.4) |
Endocrine, nutritional, or metabolic diseases | 20 (7.7) |
Diseases of the genitourinary system | 19 (7.3) |
Certain infectious or parasitic diseases | 12 (4.6) |
Neoplasms | 9 (3.5) |
Diseases of the skin | 4 (1.5) |
Diseases of the musculoskeletal system or connective tissue | 4 (1.5) |
Others | 3 (1.2) |
Comorbidities (n, (%)) | |
Hypertension | 179 (68.8) |
Diabetes mellitus | 61 (23.5) |
Dyslipidemia | 50 (19.2) |
Medications used (n, (%)) | |
ARB/ACEi | 90 (34.6) |
Calcium channel blocker | 117 (45.0) |
β-Blocker | 50 (19.2) |
Loop diuretic | 82 (31.5) |
Thiazide | 16 (6.2) |
Mineralocorticoid receptor antagonist | 33 (12.7) |
Initial evaluation of vital signs | |
Glasgow Coma Scale (points) | 14 (13–15) |
Systolic blood pressure (mmHg) | 132 (111–153) |
Diastolic blood pressure (mmHg) | 77 (65–90) |
Mean blood pressure (mmHg) | 96 (80–110) |
Heart rate (/min) | 92 (75–108) |
Respiratory rate (/min) | 23 (20–28) |
Percutaneous oxygen saturation (%) | 97 (93–98) |
Body temperature (°C) | 37.0 (36.4–37.9) |
National Early Warning Score 2 (NEWS2) | 7 (5–10) |
Shock Index (SI) | 0.67 (0.55–0.87) |
Respiratory adjusted shock index (RASI) | 1.62 (1.14–2.18) |
Quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 (n, (%)) | 100 (38.5) |
Initial arterial blood gas tests | |
pH | 7.44 (7.38–7.48) |
PaCO2 (mmHg) | 33.0 (28.3–39.8) |
PaO2 (mmHg) | 85 (67–109) |
p/F ratio | 316 (204–435) |
HCO3− (mmol/L) | 22.4 (19.3–26.0) |
Base excess (mEq/L) | −0.9 (−4.3–1.8) |
Lactate (mmol/L) | 1.5 (0.8–2.7) |
Initial peripheral blood tests | |
White blood cells (×103/μL) | 8.25 (5.76–11.53) |
Hemoglobin (g/dL) | 10.9 (9.6–12.7) |
Platelets (×103/μL) | 18.6 (14.0–23.6) |
Total bilirubin (mg/dL) | 0.7 (0.6–1.0) |
Creatinine (mg/dL) | 1.03 (0.76–1.47) |
Systemic inflammatory response syndrome (SIRS) (n, (%)) | 176 (67.7) |
ΔSequential Organ Failure Assessment (SOFA) score | 3 (1–5) |
Death within 7 Days | ||||||
---|---|---|---|---|---|---|
Cutoff | AUC (95%CI) | Sensitivity (%) | Specificity (%) | Hosmer-Lemeshow Test | p Value (vs. RASI) | |
RASI | 1.58 | 0.80 (0.73–0.87) | 96.3 | 53.6 | p = 0.10 | − |
Lactate | 2.20 | 0.73 (0.62–0.84) | 70.4 | 72.5 | p = 0.33 | 0.230 |
NEWS2 | 10 | 0.76 (0.67–0.84) | 55.6 | 82.8 | p = 0.08 | 0.221 |
Shock Index | 0.75 | 0.73 (0.62–0.83) | 74.1 | 62.7 | p = 0.53 | 0.055 |
ΔSOFA score | 4 | 0.78 (0.68–0.87) | 66.7 | 77.7 | p = 0.80 | 0.638 |
qSOFA score | 2 | 0.75 (0.66–0.84) | 70.4 | 65.2 | p = 0.56 | 0.308 |
SIRS score | 2 | 0.69 (0.60–0.78) | 63 | 66.1 | p = 0.86 | 0.028 |
Death within 30 Days | ||||||
---|---|---|---|---|---|---|
Cutoff | AUC (95%CI) | Sensitivity (%) | Specificity (%) | Hosmer-Lemeshow Test | p Value (vs. RASI) | |
RASI | 1.83 | 0.73 (0.66–0.81) | 69.4 | 70.6 | p = 0.68 | − |
Lactate | 1.60 | 0.68 (0.60–0.76) | 69.4 | 62.1 | p = 0.37 | 0.231 |
NEWS2 | 10 | 0.72 (0.65–0.80) | 49 | 85.3 | p = 0.23 | 0.698 |
Shock Index | 0.92 | 0.65 (0.56–0.74) | 38.8 | 85.3 | p = 0.81 | 0.002 |
ΔSOFA score | 4 | 0.74 (0.66–0.82) | 61.2 | 81 | p = 0.49 | 0.872 |
qSOFA score | 2 | 0.73 (0.66–0.80) | 65.3 | 67.8 | p = 0.58 | 0.860 |
SIRS score | 2 | 0.66 (0.58–0.74) | 57.1 | 67.8 | p = 0.98 | 0.081 |
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Hori, T.; Aihara, K.-i.; Watanabe, T.; Inaba, K.; Inaba, K.; Kaneko, Y.; Kawata, S.; Kawahito, K.; Kita, H.; Shimizu, K.; et al. The Respiratory Adjusted Shock Index at Admission Is a Valuable Predictor of In-Hospital Outcomes for Elderly Emergency Patients with Medical Diseases at a Japanese Community General Hospital. J. Clin. Med. 2024, 13, 4866. https://doi.org/10.3390/jcm13164866
Hori T, Aihara K-i, Watanabe T, Inaba K, Inaba K, Kaneko Y, Kawata S, Kawahito K, Kita H, Shimizu K, et al. The Respiratory Adjusted Shock Index at Admission Is a Valuable Predictor of In-Hospital Outcomes for Elderly Emergency Patients with Medical Diseases at a Japanese Community General Hospital. Journal of Clinical Medicine. 2024; 13(16):4866. https://doi.org/10.3390/jcm13164866
Chicago/Turabian StyleHori, Taiki, Ken-ichi Aihara, Takeshi Watanabe, Kaori Inaba, Keisuke Inaba, Yousuke Kaneko, Saki Kawata, Keisuke Kawahito, Hiroki Kita, Kazuma Shimizu, and et al. 2024. "The Respiratory Adjusted Shock Index at Admission Is a Valuable Predictor of In-Hospital Outcomes for Elderly Emergency Patients with Medical Diseases at a Japanese Community General Hospital" Journal of Clinical Medicine 13, no. 16: 4866. https://doi.org/10.3390/jcm13164866