Summary of shock index cut-off characteristics.

Background
Heart failure (HF) is still associated with quite considerable mortality rates and usage of simple tools for prognosis is pivotal. We aimed to evaluate the effect of shock index (SI) and its derivatives (age SI (ASI), modified SI (MSI), and age MSI (AMSI)) on acute HF (AHF) clinical outcomes.
Methods
PubMed/Medline, Scopus and Web of science databases were screened with no time and language limitations till February 2024. We recruited relevant records assessed SI, ASI, MSI or AMSI with AHF clinical outcomes.
Results
Eight records were selected (age: 69.44±15.05 years). Mean SI in those records reported mortality (either in-hospital or long-term death) was 0.67 (95% confidence interval (CI):0.63–0.72)). In-hospital and follow-up mortality rates in seven(n = 12955) and three(n = 5253) enrolled records were 6.18% and 10.14% with mean SI of 0.68(95%CI:0.63–0.73) and 0.72(95%CI:0.62–0.81), respectively. Deceased versus survived patients had higher SI difference (0.30, 95%CI:0.06–0.53, P = 0.012). Increased SI was associated with higher chances of in-hospital death (odds ratio (OR): 1.93, 95%CI:1.30–2.85, P = 0.001).The optimal SI cut-off point was found to be 0.79 (sensitivity: 57.6%, specificity: 62.1%). In-hospital mortality based on ASI was 6.12% (mean ASI: 47.49, 95%CI: 44.73–50.25) and significant difference was found between death and alive subgroups (0.48, 95%CI:0.39–0.57, P<0.001). Also, ASI was found to be independent in-hospital mortality predictor (OR: 2.54, 95%CI:2.04–3.16, P<0.001)). The optimal ASI cut-off point was found to be 49.6 (sensitivity: 66.3%, specificity: 58.6%). In terms of MSI (mean: 0.93, 95%CI:0.88–0.98)), significant difference was found specified by death/survival status (0.34, 95%CI:0.05–0.63, P = 0.021). AMSI data synthesis was not possible due to presence of a single record.
Conclusions
SI, ASI, and MSI are practical available tools for AHF prognosis assessment in clinical settings to prioritize high risk patients.

背景
心力衰竭（Heart Failure, HF）仍伴随较高的病死率，采用简便工具开展预后评估具有关键意义。本研究旨在评估休克指数（Shock Index, SI）及其衍生指标——年龄校正休克指数（Age SI, ASI）、改良休克指数（Modified SI, MSI）以及年龄校正改良休克指数（Age MSI, AMSI）对急性心力衰竭（Acute HF, AHF）临床结局的影响。
方法
本研究检索了PubMed/Medline、Scopus及Web of Science数据库，检索时限无限制，语言无限制，检索截止至2024年2月。最终纳入评估SI、ASI、MSI或AMSI与AHF临床结局相关性的相关文献记录。
结果
最终纳入8项文献记录，受试者平均年龄为69.44±15.05岁。报告病死率（包括院内死亡或远期死亡）的研究中，受试者的平均SI为0.67（95%置信区间（Confidence Interval, CI）：0.63~0.72）。在7项（样本量n=12955）报告院内死亡率、3项（n=5253）报告随访死亡率的研究中，对应死亡率分别为6.18%与10.14%，对应的平均SI分别为0.68（95%CI：0.63~0.73）与0.72（95%CI：0.62~0.81）。死亡组与存活组的SI差值存在统计学差异（0.30，95%CI：0.06~0.53，P=0.012）。SI升高与院内死亡风险增加显著相关（比值比（Odds Ratio, OR）：1.93，95%CI：1.30~2.85，P=0.001）。最佳SI截断值为0.79（灵敏度：57.6%，特异度：62.1%）。基于ASI的院内死亡率为6.12%，平均ASI为47.49（95%CI：44.73~50.25），死亡亚组与存活亚组间存在显著统计学差异（0.48，95%CI：0.39~0.57，P<0.001）。此外，ASI是独立的院内死亡预测指标（OR：2.54，95%CI：2.04~3.16，P<0.001），其最佳截断值为49.6（灵敏度：66.3%，特异度：58.6%）。针对MSI，其平均水平为0.93（95%CI：0.88~0.98），死亡/存活状态对应的组间差异具有统计学意义（0.34，95%CI：0.05~0.63，P=0.021）。由于仅纳入1项文献记录，无法完成AMSI的数据分析。
结论
SI、ASI与MSI均为临床场景中用于AHF预后评估的实用便捷工具，可用于对高危患者进行风险分层管理。