Cheyenne Snavely
University of Maryland School of Medicine
Baltimore, MD
Disclosure information not submitted.
Leena Ramadan (she/her/hers)
University of Maryland School of Medicine
Baltimore, MD
Disclosure information not submitted.
Sam Kozloff, MD
Attending Physician
Lakeview Hospital, United States
Disclosure information not submitted.
Gustavo Ospina-Tascón, MD, PhD
Director of Intensive Care Medicine
Fundación Valle del Lili - Universidad ICESI, United States
Disclosure information not submitted.
David Kaufman, MD
Director of Clinical Innovation and Education | Assistant Professor
New York University Langone Health | New York University Grossman School of Medicine, United States
Disclosure information not submitted.
Jan Bakker, MD, PhD, FCCP,FCCM
Professor, Department of Medicine
NYC Health + Hospitals Bellevue, United States
Disclosure information not submitted.
Title: DSI as a Predictor of Mortality in Patients with COVID-19
Introduction: In patients with septic shock, the diastolic shock index (DSI), defined as the ratio of heart rate to diastolic blood pressure, has been shown to correlate with mortality. This is thought to be due to the underlying vasodilation and compensatory increases in heart rate. Although infection with COVID-19 frequently presents with sepsis-like symptoms and changes in blood pressure, the role of the DSI in these patients has not been studied. Our study sought to explore if the DSI may be similarly used in patients with COVID-19 to identify individuals with an elevated mortality risk.
Methods: This was an IRB approved retrospective cohort study at a large academic hospital in New York City (NYC). Data was extracted from the electronic medical record by a trained analyst. Inclusion criteria were age 18 or older, admitted from the emergency department (ED) to the intensive care unit (ICU) between 01/01/2020 and 06/30/2020 with a positive test for COVID-19. We excluded individuals who were transferred from the floor or an outside hospital to the ICU and those with incomplete data. Our final cohort included 360 patients from NYC. The heart rate and diastolic blood pressure used to calculate the DSI were based on the first recorded vitals upon presentation to the ED. This was done in conjunction with a study at a University (ICESI) hospital in Cali, Colombia, with a combined cohort of 655 patients.
Results: The 28-day mortality rate for the combined study population was 24.9%. Descriptive statistics demonstrated a DSI of ≥ 1.6 was correlated with elevated 28 day mortality. Cox regression controlling for age, body mass index, respiratory rate, and systolic blood pressure, demonstrated that a DSI of ≥ 1.6 had a hazard ratio of 1.98 (p-value < 0.01, 95% CI 1.40-2.81).
Conclusions: In our study population, the DSI that correlated with an elevated risk of mortality was considerably lower than was seen in patients with septic shock, underscoring the physiologic differences between patients with septic shock and COVID-19. Further analysis of the data will be aimed at revealing the etiology of these differences.