Skip to main content

Effect of β-blockers and calcium channel blockers on shock index predictability in patients suffering from urosepsis

Introduction

In our busy emergency departments the identification of patients at risk of rapid hemodynamic decompensation is crucial. The shock index (SI) (pulse/systolic blood pressure) is a non-invasive clinical sign associated with more complications if higher than 0.7. The effect of β-blockers (BB) and calcium channel blockers (CCB) on the SI has not yet been described. Most studies excluded these patients, owing to the medications' effect on the cardiac pulse. Considering that BB and CCB are commonly prescribed, we studied their effect on the SI's predictability on 30-day mortality in a urosepsis population.

Methods

This single-center post-hoc analysis of prospectively collected data was conducted in an academic Canadian emergency department (ED) between March 2008 and February 2011. Data were extracted from two institutional databases. We included patients with a final diagnosis of urosepsis, sepsis, pyelonephritis and urinary tract infection. Selected patients also had a documented positive urine culture. The SI predictability on 30-day mortality was calculated for patients taking BB and/or CCB as well as patients taking none of these medications. Sensitivity and specificity were determined using ROC curves. t tests were used to compare mean SI between both groups.

Results

Our urosepsis population contained 364 patients, of which 129 (35.4%) were either using a BB, a CCB or both before their admission. Mean age was 74.9 years and 48.1% of the patients were women. A total of 36 patients died (9.9%) in a 30-day period. The group taking either BB or CCB had a significantly lower mean SI (0.76, 95% CI: 0.72 to 0.81 vs. 0.93, 95% CI: 0.89 to 0.98, P < 0.0001). In our urosepsis population, a SI of 0.7 had a sensitivity of 0.76 and a specificity of 0.27 (area under the curve (AUC): 0.596) for patients taking neither BB nor CCB. In the group taking either or both medications, a SI of 0.7 had a sensitivity of 0.57 and a specificity of 0.42 (AUC: 0.578). In both groups, lowering the SI to 0.5 increased the sensitivity to more than 0.95 but lowered specificity significantly.

Conclusion

To our knowledge this is the only study analysing the effect of BB and CCB on the SI predictability of 30-day mortality. Our results indicate that SI cannot be used to accurately predict mortality with patients suffering from urosepsis. In both our groups, SI performance was poor, as shown by the ROC curves. BB or CCB did not influence these results.

Author information

Affiliations

Authors

Corresponding author

Correspondence to J Cliche.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Cliche, J., Bourque, J.SC., Daoust, R. et al. Effect of β-blockers and calcium channel blockers on shock index predictability in patients suffering from urosepsis. Crit Care 17, P225 (2013). https://doi.org/10.1186/cc12163

Download citation

Keywords

  • Emergency Department
  • Urinary Tract Infection
  • Calcium Channel Blocker
  • Final Diagnosis
  • Pyelonephritis