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Use of the shock index to predict maternal outcomes in women referred for postpartum hemorrhage
Author(s) -
Lee SeYoung,
Kim HoYeon,
Cho GeumJoon,
Hong SoonCheol,
Oh MinJeong,
Kim HaiJoong
Publication year - 2019
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12714
Subject(s) - medicine , vital signs , blood pressure , confidence interval , intensive care unit , shock (circulatory) , receiver operating characteristic , cardiology , heart rate , obstetrics , surgery
Objective To evaluate the clinical significance of various vital signs in women referred for postpartum hemorrhage ( PPH ). Methods This retrospective study included patients with primary PPH who were referred to Korea University Medical Center, Ansan, between January 1, 2004, and December 31, 2016. We analyzed data for systolic and diastolic blood pressure, heart rate, and shock index (heart rate divided by systolic blood pressure) at time of arrival. Significant morbidity, such as massive transfusion, invasive procedures, and admission to the intensive care unit were reviewed. We used the area under the receiver operating characteristic curve ( AUROC ) for each vital sign to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed. Results 118 women with PPH were identified. The shock index had the highest AUROC to predict massive transfusion (0.815, 95% confidence interval [ CI ] 0.727–0.883). A shock index greater than 0.9 had 93.8% (95% CI 69.8–99.8) sensitivity and 51.2% (35.1–67.1) specificity for prediction of massive transfusion, and 93.6% (78.6–99.2) sensitivity and 31.0% (15.3–50.8) specificity for prediction of invasive procedures. Conclusion The shock index has significant ability to predict adverse outcomes of PPH compared with other initial vital signs when patients are referred.