Abstract
Background: Septic shock remains a leading cause of intensive care unit (ICU) mortality. This study evaluated the effectiveness of systolic shock index (SSI) and diastolic shock index (DSI) in predicting morbidity and mortality in septic shock patients.
Methods: This prospective observational cohort study was conducted at the ICU of Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia, from June 2025. Adult patients (≥18 years) with septic shock per Sepsis-3 criteria were enrolled. SSI (heart rate/systolic blood pressure) and DSI (heart rate/diastolic blood pressure) were calculated at admission. Morbidity was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. The primary outcome was mortality, and the secondary one was ICU length of stay (LOS). Receiver operating characteristic (ROC) curve analysis and Kaplan-Meier survival analysis were performed.
Results: Fifty-one patients were enrolled (mean age 53.21±15.88 years, 58.8% male). Overall mortality was 52.9% with a mean ICU stay of 14.88±12.19 days. Mean SSI and DSI were 0.98±0.18 and 1.62±0.32, respectively. Both SSI and DSI showed significant positive correlations with APACHE II (r=0.337, p=0.016 and r=0.360, p=0.009) and SOFA scores (r=0.322, p=0.021 and r=0.358, p=0.010). SSI was significantly higher in deceased patients than in surviving patients (1.035±0.165 vs 0.928±0.189, p=0.037). ROC analysis showed SSI (area under the curve [AUC] 0.644, cut-off >0.843, sensitivity 85.19%, specificity 41.67%) and DSI (AUC 0.659, cut-off >1.574, sensitivity 81.48%, specificity 66.67%) had moderate predictive ability but lacked statistical significance. APACHE II (AUC 0.876) and SOFA (AUC 0.904) demonstrated superior performance (p<0.001). DSI significantly correlated with ICU LOS (r=0.350, p=0.012).
Conclusions: SSI and DSI showed weak correlations with morbidity and moderate predictive ability for mortality in septic shock patients, but performed inferiorly to APACHE II and SOFA scores. These indices may serve as adjunctive tools but should not replace established scoring systems.
Muh. Syafaat Habib, Muhammad Rum, Andi Adil, Syafruddin Gaus, Haizah Nurdin, Ari Santri Palinrungi
