{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:39:28Z","timestamp":1785422368198,"version":"3.56.0"},"reference-count":36,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Decompensated heart failure (HF) is a serious condition that requires rapid evaluation and treatment. Shock index (SI) is a bedside predictor tool used to identify risk of mortality and morbidity.\n\nMethods: This multicentre retrospective descriptive study evaluated SI, modified shock index (MSI) and reverse shock index (RSI) as predictors of mortality in decompensated HF. Emergency department records for a 6-month period were analysed. The primary outcome was to identify if SI &gt; 0.9 could predict mortality during hospital admission. Secondary outcomes included SI &gt; 0.9, MSI &gt; 0.93 and RSI &lt; 1 for prediction of 72-h mortality, use of non-invasive positive pressure ventilation, inotropic, vasopressor or nitroglycerine infusions and need for endotracheal intubation.\n\nResults: Overall mortality during hospital admission was 4.3%, impacting internal validity. For inotrope use, SI &gt; 0.9 at 12 h produced an odds ratio (OR) of 12.33 (confidence interval [CI] 2.03\u201374.89; P = 0.006). Modified shock index &gt; 0.93 suggested potential for mortality and critical intervention prediction but lacked statistical significance. Reverse shock index &lt; 1.0 at 0 h indicated ORs of 8.89 (CI 1.11\u201370.98) for in-hospital mortality and 9.88 (CI 1.70\u201357.27) for inotrope use.\n\nConclusion: SI &gt; 0.9 at 12 h predicted an increased need for inotropes. Reverse shock index demonstrates significant predictive value for mortality and critical interventions in decompensated HF. Reverse shock index appears to be the most effective index in predicting both mortality and need for critical interventions, outperforming SI and MSI. Further prospective studies are needed to validate these findings.\n\nContribution: This research will assist with early triage of decompensated HF patients to appropriate dispositions and guide inexperienced clinicians to identify high-risk patients.<\/jats:p>","DOI":"10.4102\/jcmsa.v3i1.193","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T07:46:46Z","timestamp":1753256806000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Utility of shock index to predict mortality risk in decompensated heart failure"],"prefix":"10.4102","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3854-6548","authenticated-orcid":false,"given":"Amanda","family":"Naidoo-Pillay","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g0p6g84","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pretoria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3452-3163","authenticated-orcid":false,"given":"Suma","family":"Rajan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g0p6g84","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pretoria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9846-189X","authenticated-orcid":false,"given":"Andreas","family":"Engelbrecht","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g0p6g84","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pretoria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"#cr-split#-ref0.1","unstructured":"American Heart Association, Inc. Classes and Stages of Heart Failure. [updated 2023 Jun 07"},{"key":"#cr-split#-ref0.2","unstructured":"cited 2025 Mar 31]. Available from: https:\/\/www.heart.org\/en\/health-topics\/heart-failure\/what-is-heart-failure\/classes-of-heart-failure"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Farmakis D, Lekakis J, Filippatos G. Acute heart failure: Epidemiology, risk factors, and prevention. Rev Esp Cardiol. 2015;68:245\u2013248. https:\/\/doi.org\/10.1016\/j.recesp.2014.11.009","DOI":"10.1016\/j.rec.2014.11.004"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Kurmani S, Squire I. Acute heart failure: Definition, classification and epidemiology. Curr Heart Fail Rep. 2017;14(5):385\u2013392.","DOI":"10.1007\/s11897-017-0351-y"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Gheorghiade M, Abraham WT, Albert NM, et al. OPTIMIZE-HF Investigators and Coordinators. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296(18):2217\u20132226. https:\/\/doi.org\/10.1001\/jama.296.18.2217","DOI":"10.1001\/jama.296.18.2217"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Collins SP, Lindsell CJ, Jenkins CA, et al. Risk stratification in acute heart failure: Rationale and design of the STRATIFY and DECIDE studies. Am Heart J. 2012;164(6):825\u2013834. https:\/\/doi.org\/10.1016\/j.ahj.2012.07.033","DOI":"10.1016\/j.ahj.2012.07.033"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Collins SP, Pang PS, Fonarow GC, Yancy CW, Bonow RO, Gheorghiade M. Is hospital admission for heart failure really necessary? The role of the ED and observation unit in preventing hospitalization and rehospitalization. J Am Coll Cardiol. 2013;61(2):121\u2013126.","DOI":"10.1016\/j.jacc.2012.08.1022"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Rame JE, Sheffield MA, Dries DL, et al. Outcomes after emergency department discharge with a primary diagnosis of heart failure. Am Heart J. 2001;142(4):714\u2013719. https:\/\/doi.org\/10.1067\/mhj.2001.118473","DOI":"10.1067\/mhj.2001.118473"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Chin MH, Goldman L. Correlates of major complications or death in patients admitted to the hospital with congestive heart failure. Arch Intern Med. 1996;156(16):1814\u20131820.","DOI":"10.1001\/archinte.1996.00440150068007"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Egbujie BA, Igumbor EU, Puoane T. A cross-sectional study of socioeconomic status and cardiovascular disease risk among participants in the Prospective Urban Rural Epidemiological (PURE) Study. S Afr Med J. 2016;106(9):900\u2013906. https:\/\/doi.org\/10.7196\/SAMJ.2016.v106i9.10456","DOI":"10.7196\/SAMJ.2016.v106i9.10456"},{"key":"#cr-split#-ref9.1","unstructured":"Rising non-communicable diseases: A looming health crisis [homepage on the Internet]. Stats SA, Department: Statistics South Africa. C17 October 2023 [updated 2023 Oct 17"},{"key":"#cr-split#-ref9.2","unstructured":"cited 2024 May 23]. Available from: https:\/\/www.statssa.gov.za\/?p=16729"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Montoya KF, Charry JD, Calle-Toro JS, N\u00fa\u00f1ez LR, Poveda G. Shock index as a mortality predictor in patients with acute polytrauma. J Acute Dis. 2015;4(3):202\u2013204. https:\/\/doi.org\/10.1016\/j.joad.2015.04.006","DOI":"10.1016\/j.joad.2015.04.006"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"McCall SJ, Musgrave SD, Potter JF, et al. The shock index predicts acute mortality outcomes in stroke. Int J Cardiol. 2015;182:523\u2013527. https:\/\/doi.org\/10.1016\/j.ijcard.2014.12.175","DOI":"10.1016\/j.ijcard.2014.12.175"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Huang B, Yang Y, Zhu J, et al. Usefulness of the admission shock index for predicting short-term outcomes in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2014;114:1315\u20131321.","DOI":"10.1016\/j.amjcard.2014.07.062"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Sam A, Sanchez D, Gomez V, et al. The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism. Eur Respir J. 2011;37:762\u2013766. https:\/\/doi.org\/10.1183\/09031936.00070110","DOI":"10.1183\/09031936.00070110"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med. 1994;24(4):685\u2013690. https:\/\/doi.org\/10.1016\/S0196-0644(94)70279-9","DOI":"10.1016\/S0196-0644(94)70279-9"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Liu Y, Liu J, Fang ZA, et al. Modified shock index and mortality rate of emergency patients. World J Emerg Med. 2012;3(2):114\u2013117. https:\/\/doi.org\/10.5847\/wjem.j.issn.1920-8642.2012.02.006","DOI":"10.5847\/wjem.j.issn.1920-8642.2012.02.006"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Abreu G, Azevedo P, Braga CG, et al. Modified shock index: A bedside clinical index for assessment of ST-segment elevation myocardial infarction at presentation. Rev Port Cardiol (Engl Ed). 2018;37(6):481\u2013488.","DOI":"10.1016\/j.repc.2017.07.018"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Chuang JF, Rau CS, Wu SC, et al. Use of the reverse shock index for identifying high-risk patients in a five-level triage system. Scand J Trauma Resusc Emerg Med. 2016;24:12. https:\/\/doi.org\/10.1186\/s13049-016-0208-5","DOI":"10.1186\/s13049-016-0208-5"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"El-Menyar A, Sulaiman K, Almahmeed W, et al. Shock index in patients presenting with acute heart failure: A multicentre multinational observational study. Angiology. 2019;70(10):938\u2013946. https:\/\/doi.org\/10.1177\/0003319719857560","DOI":"10.1177\/0003319719857560"},{"key":"ref19","unstructured":"Borke J, Schraga ED, Schrediber D, et al. Natriuretic peptides in congestive heart failure. Medscape (WebMD LLC group) based in Newark, New Jersey, USA; 2019."},{"key":"ref20","unstructured":"Gounden V, Jialal I. Renal function tests. Stat pearls LLC based in Treasure Island, Florida, USA; 2019."},{"key":"ref21","unstructured":"Workeneh BT, Mamlouk O, Agraharkar M, et al. Acute Kidney Injury (AKI). New Jersey, USA: Medscape; 2024."},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Soman S, Aurora L. Type 3 cardiorenal syndrome. In: McCullough PA, Ronco C, editors. Textbook of Cardiorenal Medicine. Cham: Springer International Publishing; 2021. p. 95\u2013110.","DOI":"10.1007\/978-3-030-57460-4_9"},{"key":"ref23","unstructured":"Xing TJ, Clinical classification of liver failure: Consensus, contraindications and new recommendations. J Clin Gastroenterol Hepatol. 2017;1:2. https:\/\/doi.org\/10.21767\/25757733.10000016"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181\u20131247. https:\/\/doi.org\/10.1007\/s00134-021-06506-y","DOI":"10.1007\/s00134-021-06506-y"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Barnes R, Clarke D, Farina Z, et al. Vital sign based shock scores are poor at triaging South African trauma patients. Am J Surg. 2018;216(2):235\u2013239.","DOI":"10.1016\/j.amjsurg.2017.07.025"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Costa YC, C\u00e1ceres L, Mauro V, et al. Shock index, modified shock index, and age-adjusted shock index as predictors of in-hospital death in acute heart failure. Sub analysis of the ARGEN IC. Curr Probl Cardiol. 2022;47(10):101309. https:\/\/doi.org\/10.1016\/j.cpcardiol.2022.101309","DOI":"10.1016\/j.cpcardiol.2022.101309"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Oh GC, An S, Lee HY, et al. Modified reverse shock index predicts early outcomes of heart failure with reduced ejection fraction. ESC Heart Fail. 2022;9(5):3232\u20133240.","DOI":"10.1002\/ehf2.14031"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Sotello D, Yang S, Nugent K. Comparison of the shock index, modified shock index, and age shock index in adult admissions to a tertiary hospital. Southwest Respir Crit Care Chron. 2019;7(28):18\u201323. https:\/\/doi.org\/10.12746\/swrccc.v7i28.539","DOI":"10.12746\/swrccc.v7i28.539"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Torabi M, Mirafzal A, Rastegari A, et al. Association of triage time shock index, modified shock index, and age shock index with mortality in emergency severity index level 2 patients. Am J Emerg Med. 2016;34:63\u201368. https:\/\/doi.org\/10.1016\/j.ajem.2015.09.014","DOI":"10.1016\/j.ajem.2015.09.014"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Heidarpour M, Sourani Z, Vakhshoori M, et al. Prognostic utility of shock index and modified shock index on long-term mortality in acute decompensated heart failure. Persian registry of cardiovascular disease\/heart failure (PROVE\/HF) study. Acta Cardiol. 2022;78(2):217\u2013226. https:\/\/doi.org\/10.1080\/00015385.2022.2030554","DOI":"10.1080\/00015385.2022.2030554"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Vakhshoori M, Bondariyan N, Sabouhi S, et al. Impact of shock index, modified SI, and age-derivative indices on acute heart failure prognosis; A systematic review and meta-analysis. PLoS One. 2024;19(12):e0314528. https:\/\/doi.org\/10.1371\/journal.pone.0314528","DOI":"10.1371\/journal.pone.0314528"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Nkoke C, Damasceno A, Edwards C, et al. Differences in socio-demographic and risk factor profile, clinical presentation, and outcomes between patients with and without RHD heart failure in Sub-Saharan Africa: Results from the THESUS-HF registry. Cardiovasc Diagn Ther. 2021;11(4):980\u2013990. https:\/\/doi.org\/10.21037\/cdt-21-112","DOI":"10.21037\/cdt-21-112"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895\u2013e1032. https:\/\/doi.org\/10.1161\/CIR.0000000000001073","DOI":"10.1161\/CIR.0000000000001073"}],"container-title":["Journal of the Colleges of Medicine of South Africa"],"original-title":[],"deposited":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T07:46:59Z","timestamp":1753256819000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/view\/193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,24]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/jcmsa.v3i1.193","relation":{},"ISSN":["2960-110X"],"issn-type":[{"value":"2960-110X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,24]]},"article-number":"a193"}}