Age-Adjusted Shock Index as a Tool to Predict Mortality in Pediatric Patients with Dengue

Abstract

Introduction: The pediatric age-adjusted shock index (SIPA), defined as the ratio between heart rate (HR) and systolic blood pressure (SBP), is widely used as a predictor in patients with trauma or acute hemorrhage and in hypovolemic shock. Since dengue can lead to a state of shock, this index may be useful as a prognostic marker of severity.

Objective: To identify the relationship between SIPA and the risk of morbidity and mortality in patients aged 1 to 17 years with dengue presenting with warning signs or severe dengue.

Methods: Observational, descriptive, prospective, cross-sectional study. A total of 145 pediatric patients diagnosed with dengue with warning signs or severe dengue were included, treated between February 1, 2024, and August 31, 2024, at Mario Catarino Rivas Hospital. The shock index was assessed upon admission and 24 hours later.

Results: Patients aged 1 to 6 years presented the highest SIPA values at admission, with a median close to 1.1, which decreased significantly after 24 hours. In deceased patients, SIPA was significantly higher both at admission and 24 hours later, with a fatal outcome. In patients older than 12 years, SIPA values were lower at admission and at 24 hours. Sex-based analysis showed that females had a significantly higher SIPA at admission (p = 0.0166). No statistically significant association was found between SIPA and admission to the PICU (p = 0.36).

Conclusion: As a mortality predictor, SIPA was significantly higher in patients who died. Improvement in SIPA was associated with favorable clinical evolution.