Diastolic Shock Index (DSI)
Evaluates the risk of septic shock in patients presenting with sepsis or suspected infection.
Use vital signs obtained at triage, early in the emergency department (ED) visit, or upon admission.
Advice
- Not a diagnostic test and can be abnormal in a variety of conditions; results should be used as an adjunct to serum lactate and the overall clinical picture.
- Diastolic parameters are most accurate when the aortic valve is competent; factors that may influence interpretation include:
- Severe aortic regurgitation (can pathologically lower diastolic blood pressure, mimicking vasodilation).
- Baseline heart rate variability.
- Medications (e.g., beta-blockers may blunt tachycardia in shock states).
- Autonomic dysfunction.
Management
- While a universally agreed-upon cutoff value is currently lacking, a result ≥2.0 is frequently cited as a clinically significant threshold; any elevation should raise concern for progression to septic shock.
- Clinicians should promptly consider early, aggressive resuscitation, including vasopressor and fluid therapy, in the setting of an elevated DSI.
- Sepsis is continually evolving; refer to the Surviving Sepsis Campaign 2026 guidelines for detailed guidance.
Critical Actions
- Results should not replace clinical gestalt or other indicators of sepsis or septic shock, including:
- Persistent SBP <90 mmHg or MAP <65 after fluid resuscitation.
- Altered mental status.
- Respiratory distress or need for airway support.
- Delayed capillary refill.
- Elevated lactate.
- Maintain a high index of suspicion for mimics of sepsis, such as hemorrhagic, cardiogenic, and obstructive shock or toxicologic causes; this tool does not apply to these etiologies.
- This tool may underperform in certain populations; use caution in:
- Pregnant or postpartum patients.
- Immunosuppressed patients.
- Pediatric patients.