PEDIATRIC AGE-ADJUSTED SHOCK INDEX IN SEPSIS: A PREDICTOR OF MORTALITY IN THE INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Abstract

Background: Sepsis remains a major cause of morbidity and mortality in pediatric intensive care units, especially in low and middle-income countries such as Pakistan. Early detection of hemodynamic compromise is crucial to improving clinical outcomes. The Shock Index Pediatric Age-Adjusted (SIPA) offers a non-invasive, rapid method for risk stratification and may serve as a valuable prognostic tool. Objective: To evaluate whether abnormal SIPA values at admission and 24 hours post-admission are associated with increased mortality and adverse outcomes in children with sepsis. Study Design: Prospective observational cohort study. Setting: Pediatric Intensive Care Unit (PICU), The Children’s Hospital, Lahore. Duration of Study: from March 2024 to March 2025. Methods: A total of 200 children aged 1 to 17 years with clinically diagnosed sepsis were enrolled using non-probability consecutive sampling. SIPA was calculated using heart rate and systolic blood pressure, categorized as normal or abnormal based on age-adjusted thresholds. Clinical outcomes assessed included mortality, mechanical ventilation (MV) requirement, inotropic support, and ICU length of stay. Statistical analysis was performed using SPSS version 26, including logistic regression to determine associations between SIPA and outcomes. Results: Abnormal SIPA was observed in 57% of patients at admission and in 38.5% at 24 hours. Persistently abnormal SIPA was significantly associated with higher mortality (21.6%) compared to patients with normalized SIPA (6.5%, P = 0.008). Abnormal SIPA at 24 hours was independently associated with increased mortality (OR = 3.92; 95% CI: 1.58–9.72; P = 0.003), need for mechanical ventilation (OR = 2.45; 95% CI: 1.38–4.35; P = 0.002), and prolonged ICU stay (mean increase: 2.4 days; P = 0.01). Conclusion: SIPA is a practical and effective bedside tool with strong prognostic value in pediatric sepsis. Monitoring SIPA at admission and 24 hours post-admission can aid early identification of high-risk patients, allowing timely interventions to improve outcomes, particularly in resource-limited healthcare settings.