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Inadequacy of the shock index as a predictor of refractory primary postpartum hemorrhage: a secondary analysis of the prospective multicenter HELP MOM study
Position du problème et objectif(s) de l’étude
The ability to predict severe and refractory primary postpartum hemorrhage (PPH) remains ambiguous and contentious. Therefore, the objective of this study was to evaluate the prognostic utility of the shock index in forecasting refractory PPH.
Matériel et méthodes
This study involved a secondary analysis of a multicenter, prospective, observational study investigating the correlation between severe postpartum hemorrhage (PPH) and the subsequent development of psychological disorders. Participants included patients who experienced severe PPH, characterized by blood loss of ≥1000 mL necessitating the administration of sulprostone. The shock index, defined as the ratio of heart rate to systolic blood pressure, was recorded at two time points: at the initiation of sulprostone treatment (T1) and at the most severe instance prior to study inclusion (T0). Refractory PPH was defined by the requirement for blood product transfusion, interventional radiology, or laparotomy (excluding cesarean section). The predictive efficacy of the shock index was assessed using univariate and multivariate logistic regression, as well as the area under the receiver operating characteristic curve (AUROC).
Résultats & Discussion
From November 2014 to November 2016, 332 patients experienced severe PPH, with 316 included in the final analysis. The prevalence of refractory-PPH was 35.4% (112/316). A shock index at T1 ≥ 0.9, as well as an increase in the shock index, were independently associated with the occurrence of refractory-PPH, with odds ratios of 2.50 (95% confidence interval [CI] 1.40-4.50) and 2.42 (95% CI 1.20-4.95), respectively. The AUROC for the shock index at T1 was 0.61 (95% CI 0.55-0.68), and for the difference in shock index between T1 and T0, it was 0.60 (95% CI 0.53-0.69).
Conclusion
The shock index measured at the initiation of sulprostone did not satisfactorily predict refractory primary postpartum hemorrhage.
Auteurs
M.A. Daghmouri (1), E. Weiss (2), M.P. Bonnet (3), M. Le Guen (4), D. Michelet (5), S. Dahmani (6), A.S. Ducloy Bouthors (7), A. Mebazaa (8), E. Gayat (8), B. Deniau (9)