Shock index and early warning score in liver cancer rupture shock

doi:10.4240/wjgs.v17.i10.109999

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Oct 27, 2025 (publication date) through Nov 16, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Oct 27, 2025; 17(10): 109999
Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.109999

Shock index and early warning score in liver cancer rupture shock

Ji-Fen Ma, Li Jin, Ling Sha, Hong-Fang Li, Xiang-Yun Qian, Hai-Yan Wang

Ji-Fen Ma, Li Jin, Ling Sha, Hong-Fang Li, Xiang-Yun Qian, Hai-Yan Wang, Department of Emergency, Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226000, Jiangsu Province, China

Co-corresponding authors: Xiang-Yun Qian and Hai-Yan Wang.

Author contributions: Ma JF designed the study; Ma JF, Jin L, Sha L, and Li HF contributed to the analysis of the manuscript; Ma JF and Jin L were involved in the data collection and writing of this article. All the authors have read and approved the final manuscript. Qian XY and Wang HY equally supervised the research and manuscript preparation (designated as co-corresponding authors). Qian XY and Wang HY, as co-corresponding authors, made equal and significant contributions to the research. They jointly supervised the entire research process, providing guidance on the implementation of the study design formulated by Ma JF. In terms of manuscript preparation, they worked collaboratively to oversee the refinement of the content, ensuring that the analysis and writing by Ma JF, Jin L, Sha L, and Li HF met academic standards. They also took shared responsibility for addressing issues that arose during the research and manuscript development, playing a crucial role in ensuring the quality and integrity of the work. Both are responsible for corresponding with relevant parties regarding the study.

Supported by Clinical Medicine Special Research Fund Project of Nantong University, No. 2024HZ001 and No. 2022HY009.

Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Nantong Third People's Hospital and Affiliated Nantong Hospital 3 of Nantong University.

Informed consent statement: All study participants and their legal guardians provided written informed consent before enrollment.

Conflict-of-interest statement: The authors report no relevant conflicts of interest.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Xiang-Yun Qian, Dean, Department of Emergency, Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, No. 60 Qingnian Middle Road, Chongchuan District, Nantong 226000, Jiangsu Province, China. qxy3066@163.com

Received: July 1, 2025
Revised: August 1, 2025
Accepted: August 18, 2025
Published online: October 27, 2025
Processing time: 114 Days and 23.3 Hours

Abstract

BACKGROUND

Primary liver cancer is a globally prevalent malignancy, with China accounting for approximately 55% of new cases, and is linked to hepatitis B, aflatoxin, and cirrhosis. Its rupture with hemorrhagic shock is a lethal complication with high mortality, and traditional triage struggles with timely risk stratification, necessitating better tools, such as the integrated shock index (SI)-early warning score (EWS).

AIM

To study and analyze the combined effect of the SI and EWS in primary liver cancer patients with ruptured hemorrhage and shock.

METHODS

In total, 118 patients who visited the Emergency Department of Nantong Third People's Hospital from January 2023 to December 2024 were selected and randomly divided into a control group (59 patients who received routine emergency treatment) and an observation group (59 patients who received condition assessment and intervention by combining the SI and EWS based on routine emergency treatment). The clinical treatment outcomes, respiratory function indicators, serological indicators, complications, and satisfaction with emergency intervention before and after the emergency intervention were compared between the two groups.

RESULTS

The emergency, triage, waiting, and hemostasis times, as well as hospital stay were shorter in the observation group than in the control group (P < 0.05). After 48 hours of emergency intervention, blood oxygen saturation and partial pressure of oxygen in the observation group were higher than those in the control group (P < 0.05). Seven days after emergency intervention, the hemoglobin, prealbumin, and albumin levels were higher in the observation group than in the control group (P < 0.05). The complication rate in the observation group was 3.39%, lower than that in the control group (13.56%; P < 0.05). Satisfaction with emergency intervention in the observation group was 94.92%, higher than 83.05% in the control group (P < 0.05).

CONCLUSION

The combined application of the SI and EWS in patients with primary liver cancer rupture, hemorrhage, and shock can significantly shorten emergency treatment time, improve respiratory function and serological indicators, reduce the incidence of complications, and enhance patient satisfaction with emergency interventions, with higher clinical treatment efficiency and quality. Therefore, it is worthy of promotion and application.

Keywords: Primary liver cancer; Rupture hemorrhage; Shock index; Early warning score system; Complications

Core Tip: This study demonstrated that combining the shock index (SI, heart rate/systolic blood pressure ratio) with the early warning score (EWS) significantly improves outcomes in primary liver cancer rupture hemorrhage. The SI-EWS protocol reduced emergency response time by 32% and complication rates by 75% (3.39% vs 13.56%), and increased patient satisfaction to 94.92%. This integrated approach enhances hemodynamic monitoring accuracy, enabling faster hemorrhage control and better preservation of respiratory function and nutritional status (hemoglobin/prealbumin levels). These findings support the use of SI-EWS as a standardized triage tool for high-risk abdominal hemorrhage cases.