The effectiveness of shock indices in predicting mortality in acute pulmonary embolism

References

1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi:10.1093/eurheartj/ehz405
   Article · PubMed · Google Scholar
2. Huisman MV, Barco S, Cannegieter SC, et al. Pulmonary embolism. Nat Rev Dis Primers. 2018;4:18028. doi:10.1038/nrdp.2018.28
   Article · PubMed · Google Scholar
3. Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA. Shock index in the emergency department: utility and limitations. Open Access Emerg Med. 2019;11:179-199. doi:10.2147/oaem.s178358
   Article · PubMed · Google Scholar
4. Gökçek K, Gökçek A, Demir A, Yıldırım B, Acar E, Alataş OD. In-hospital mortality of acute pulmonary embolism: predictive value of shock index, modified shock index, and age shock index scores. Med Clin (Barc). 2022;158(8):351-355. doi:10.1016/j.medcli.2021.04.035
   Article · PubMed · Google Scholar
5. Spampinato MD, Covino M, Passaro A, et al. Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score. Clin Exp Emerg Med. 2023;10(1):26-36.
   PubMed · Google Scholar
6. Çağlar A, Akıllı NB, Köylü R, Alpaydın MS. Jugular vein diameter: a new player in normotensive pulmonary embolism. Clin Imaging. 2021;74:4-9. doi:10.1016/j.clinimag.2020.12.034
   Article · PubMed · Google Scholar
7. Toosi MS, Merlino JD, Leeper KV. Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism. Am J Cardiol. 2008;101(5):700-705. doi:10.1016/j.amjcard.2007.10.038
   Article · PubMed · Google Scholar
8. Keller K, Coldewey M, Geyer M, Beule J, Balzer JO, Dippold W. Shock index for outcome and risk stratification in acute pulmonary embolism. Artery Res. 2016;15:30-35. doi:10.1016/j.artres.2016.05.002
   Article · PubMed · Google Scholar
9. Otero R, Trujillo-Santos J, Cayuela A, et al. Hemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index? Eur Respir J. 2007;30(6):1111-1116. doi:10.1183/09031936.00071007
   Article · PubMed · Google Scholar
10. Kara H, Degirmenci S, Bayir A, Ak A. Pulmonary embolism severity index, age-based markers and evaluation in the emergency department. Acta Clin Belg. 2015;70(4):259-264.
    PubMed · Google Scholar
11. Zhou J, Shan PR, Xie QL, et al. Age shock index and age-modified shock index are strong predictors of outcomes in ST-segment elevation myocardial infarction patients undergoing emergency percutaneous coronary intervention. Coron Artery Dis. 2019;30(6):398-405. doi:10.1097/mca.0000000000000759
    Article · PubMed · Google Scholar
12. Bondariyan N, Vakhshoori M, Sadeghpour N, Shafie D. Prognostic value of shock index, modified shock index, and age-adjusted derivatives in prediction of in-hospital mortality in patients with acute decompensated heart failure: Persian Registry of Cardiovascular Disease/Heart Failure Study. Anatol J Cardiol. 2022;26(3):210-217. doi:10.5152/anatoljcardiol.2021.671
    Article · PubMed · Google Scholar
13. Dalmau R. The diastolic shock index works…but what is it? Ann Intensive Care. 2020;10:103. doi:10.1186/s13613-020-00720-5
    Article · PubMed · Google Scholar
14. Ospina-Tascón GA, García-Gallardo G, Orozco N. Using the diastolic shock index to determine when to promptly administer vasopressors in patients with septic shock. Clin Exp Emerg Med. 2022;9(4):367-369. doi:10.15441/ceem.22.401
    Article · PubMed · Google Scholar
15. Kim DS, Park JE, Hwang SY, et al. Prediction of vasopressor requirement among hypotensive patients with suspected infection: usefulness of diastolic shock index and lactate. Clin Exp Emerg Med. 2022;9(3):176-186. doi:10.15441/ceem.22.324
    Article · PubMed · Google Scholar
16. Avci M, Doganay F. Prognostic performance of shock index, diastolic shock index, age shock index, and modified shock index in COVID-19 pneumonia. Disaster Med Public Health Prep. 2022;17:e189.
    PubMed · Google Scholar
17. Lai WH, Wu SC, Rau CS, Kuo PJ, Hsu SY, Chen YC. Systolic blood pressure lower than heart rate upon arrival at and departure from the emergency department indicates a poor outcome for adult trauma patients. Int J Environ Res Public Health. 2016;13(6):528. doi:10.3390/ijerph13060528
    Article · PubMed · Google Scholar

Figures

Fullscreen

Figure 1. Flowchart of this research

Fullscreen

Figure 2. AUC value of shock indices in predicting the mortality of pumonary embolism patients. a; ROC curve of ASI, DSI, SI, MSI, MSIA, PESI. b; ROC curve of DBP, SBP, MAP, rSI, rSIA

Tables

Table 1. Clinical characteristics of pulmonary embolism patients

Fullscreen

Abbreviations: PE, pulmonary embolism; DVT, deep-vein thrombosis.

Table 2. Distribution of shock indices according to mortality

Fullscreen

Abbreviations: ICU: intensive care unit; DBP, diastolic blood pressure; SBP, systolic blood pressure; MAP, mean arterial pressure; SI, shock index; DSI, diastolic shock index; MSI, modified shock index; ASI, age shock index; rSI, reverse shock index; MSIA, MSI multiplied by age; rSIA, rSI multiplied by age; PESI, pulmonary embolism severity index. *: median (interquartile range); : n (%);*: mean ± standard deviation.

Table 3. Optimal cut-point values in predicting hospital mortality for shock indices in pulmonary embolism patients

Fullscreen

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; AUC, area under the curve.