Modified Shock Index (MSI)

Prognostic Value of Modified Shock Index in Patients With Sepsis Presenting to the Emergency Department

The Emergence of Modified Shock Index (MSI) To further enhance the assessment of hemodynamic stability, the modified shock index (MSI) was developed. The MSI is defined as the ratio of heart rate to mean arterial pressure (MAP) This index takes into account the effect of diastolic blood pressure by replacing SBP with MAP in the calculation . The modified shock index has proven to be a superior predictor of mortality compared to traditional SI . It outperforms heart rate, systolic blood pressure, diastolic blood pressure, and SI as individual predictors

Study Overview

• Status: Not yet recruiting
• Conditions: Sepsis
• Intervention / Treatment: Other: Chest x-ray; Diagnostic test: CBC

Detailed Description

Sepsis is defined as a "life-threatening organ dysfunction due to a dysregulated host response to infection". Despite high treatment expense, sepsis is often fatal . Many a times, Sepsis is diagnosed late, and proper treatment is delayed. When Sepsis is identified early in emergency department (ED) and aggressive therapy is initiated early, the mortality and morbidity rates can be significantly reduced because most cases of sepsis present in the ED and in the wards rather than the intensive care unit (ICU) Septic shock is a subset of sepsis characterized by persistent circulatory, cellular, and metabolic abnormalities associated with a higher risk of mortality,Clinically (Sepsis-3 definition) :- Sepsis with hypotension requiring vasopressors to maintain/ MAP ≥ 65 mmHg/AND serum lactate > 2 mmol/L/ Despite adequate fluid resuscitation The shock index (SI) is a simple and reliable formula used to evaluate the physiological response in cardiovascular performance prior to systemic hypotension. It is calculated by dividing the heart rate by the systolic blood pressure(SBP) This ratio was first introduced by Allgower and Buri in 1967 as an inexpensive method to assess the degree of hypovolemia in hemorrhagic and infectious shock The non-invasive nature of this measurement makes it valuable in providing consistent hemodynamic data. SI serves as a crucial metric for determining the level of tissue perfusion Moreover, it enables the assessment of the severity of hypovolemic shock The Emergence of Modified Shock Index (MSI) To further enhance the assessment of hemodynamic stability, the modified shock index (MSI) was developed. The MSI is defined as the ratio of heart rate to mean arterial pressure (MAP) This index takes into account the effect of diastolic blood pressure by replacing SBP with MAP in the calculation . The modified shock index has proven to be a superior predictor of mortality compared to traditional SI . It outperforms heart rate, systolic blood pressure, diastolic blood pressure, and SI as individual predictors

• Study Type: Observational
• Enrollment (Estimated): 70

Contacts and Locations

• Study Contact: Name: Heba M Sadek, Master; Phone Number: 020 01022943631; Email: heba05988@gmail.com
• Study Contact Backup: Name: Nayel A Zaki, Professor; Phone Number: 020 010 17606718; Email: heba05988@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

People above 18 years old presenting with sepsis

Description

Inclusion Criteria:

Age ≥ 18 years Presentation to the ED with sepsis(Suspected or confirmed infection plus Evidence of organ dysfunction) (SOFA score ≥ 2 from baseline)

Exclusion Criteria:

• Pregnancy

  • * poly traumatized patients
  • * Cardiac arrest on arrival
  • * Patients with significant cardiac arrhythmia including atrial fibrillation with rapid ventricular response, or pacemaker-dependent rhythms
  • * Patients transferred from another hospital after initial resuscitation

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
assess the ability of Modified Shock Index (MSI) at Emergency Department presentation to predict in-; evaluate the association between MSI and: Intensive care unit (ICU) admission; Need for vasopressor support; Need for mechanical ventilation; Length of hospital stay	Other: Chest x-ray; Smear from sputum or urine to identify the site of infection; Other Names: Sputum culture; Urine culture; Diagnostic test: CBC; Identify the infection by sepsis markers; Other Names: ESR; CRP; Kidney function tests

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Modified Shock Index in patients with sepsis presenting to the Emergency Department	To assess the Modified Shock Index (MSI), calculated as the ratio of heart rate (beats per minute) to mean arterial pressure (mmHg), in adult patients presenting with sepsis to the Emergency Department, and evaluate its prognostic value.	At baseline (upon presentation to the Emergency Department)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
1. Association between Modified Shock Index and ICU admission 2. Association between Modified Shock Index and vasopressor requirement 3-Association between MSI and need for mechanical ventilation 4_Association between MSI and length of hospital stay	To determine the association between the Modified Shock Index measured at Emergency Department presentation and the need for Intensive Care Unit (ICU) admission.; To evaluate the relationship between the Modified Shock Index measured at Emergency Department presentation and the requirement for vasopressor support.; To determine the association between the Modified Shock Index measured at Emergency Department presentation and the requirement for invasive mechanical ventilation. 4_To evaluate the relationship between the Modified Shock Index measured at Emergency Department presentation and the total duration of hospital stay.	1_Within 24 hours of Emergency Department presentation. 2_During the first 24 hours of hospital admission. 3_During the first 24 hours of hospital admission. 4_From hospital admission until hospital discharge.

Collaborators and Investigators

• Sponsor: Sohag University
• Investigators: Principal Investigator: Heba M Sadek, Master, Sohag University

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): April 1, 2027

Study Registration Dates

• First Submitted: February 27, 2026
• First Submitted That Met QC Criteria: March 15, 2026
• First Posted (Actual): March 18, 2026

Study Record Updates

• Last Update Posted (Actual): March 18, 2026
• Last Update Submitted That Met QC Criteria: March 15, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Modified shock index
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Systemic Inflammatory Response Syndrome; Inflammation; Pathological Conditions, Signs and Symptoms; Sepsis; Diagnostic Techniques and Procedures; Diagnosis; Physical Phenomena; Electromagnetic Phenomena; Magnetic Phenomena; Electromagnetic Radiation; Radiation; Radiation, Ionizing; Diagnostic Techniques, Urological; X-Rays; Kidney Function Tests
• Other Study ID Numbers: Soh-Med-26-2-14MS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: As the data will be reviewed by supervisor and editors

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No