Revised shock index for clinical decision-making and optimal referral timing in managing severe postpartum hemorrhage during cesarean section: a retrospective case-control study

The PPH group (n=231) comprised patients with intraoperative blood loss ≥1 000 ml, while controls (n=231) without PPH were randomly selected. Comparative analysis of clinical characteristics identified PPH risk factors.

Receiver operating characteristic (ROC) curves assessed traditional and various revised shock indices' predictive performance for: (1) blood loss ≥1 000 ml, (2) transfusion requirement, (3) hysterectomy, and (4) ICU admission. Correlation analyses examined relationships between peak shock index (peak SI), delta shock index (ΔSI), delta hemoglobin (delta Hb), and intraoperative blood loss.​Results ​ For predicting blood loss ≥1 000 ml, transfusion, and hysterectomy, ΔSI demonstrated optimal area under curve (AUC) values: 0.727 (95%CI: 0.681-0.772), 0.741 (95%CI: 0.696-0.786), and 0.812 (95%CI: 0.710-0.915), respectively.