Comparative Prognostic Value of the Shock Index, Modified Shock Index, and Simplified Pulmonary Embolism Severity Index in Predicting Short-Term Outcomes in Patients with Acute Pulmonary Embolism
Abstract
Background: This study aims to evaluate the predictive performance of the shock index (SI), modified SI (mSI), and Simplified Pulmonary Embolism Severity Index (sPESI) for intensive care unit (ICU) admission and 30-day mortality in patients presenting to the emergency department (ED) with pulmonary embolism (PE).
Methods: A retrospective medical record review was conducted in the EDs of two hospitals in different cities. Records were reviewed, and patients diagnosed with PE in the ED were included. Patients’ SI, mSI, and sPESI were calculated, and they were divided into high- and low-risk groups based on their sPESI. The prognostic value of these parameters in predicting ICU admission and 30-day mortality was assessed using receiver operating characteristic (ROC) curves.
Results: This study included 135 patients with a median age of 71.8 (22–95) years, of which 68 (50%) were female. While 38 (28%) were followed up in the ICU, 15 (11%) died within 30 days. Based on the sPESI, 38 were in the low-risk group and 97 in the high-risk group. Mortality was higher in the high-risk group, and no deaths occurred in the low-risk group. The SI, mSI, and sPESI were significantly higher among patients admitted to the ICU or who died.
Conclusion: While the SI, mSI, and sPESI appear similar in predicting ICU admission and 30-day mortality, the mSI was more effective in predicting ICU admission, and the sPESI was more effective in predicting mortality.
Keywords
30-day mortality, ICU admission, in-hospital mortality, length of hospital stay, sPESI
Supporting Institution
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Ethical Statement
The study was approved by the Local Ethics Committee of Selcuk University Faculty of Medicine (approval number: 2024/345, date: 02.07.2024).
Thanks
None
References
- Corrigan D, Prucnal C, Kabrhel C. Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients. Clin Exp Emerg Med. 2016;3(3):117-25.
- Aujesky D, Roy PM, Le Manach CP, Verschuren F, Meyer G, Obrosky DS, et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J. 2006;27(4):476-81.
- Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al; RIETE Investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-9.
- Torabi M, Moeinaddini S, Mirafzal A, Rastegari A, Sadeghkhani N. Shock index, modified shock index, and age shock index for prediction of mortality in Emergency Severity Index level 3. Am J Emerg Med. 2016;34(11):2079-83.
- Liu YC, Liu JH, Fang ZA, Shan GL, Xu J, Qi ZW, et al. Modified shock index and mortality rate of emergency patients. World J Emerg Med. 2012;3(2):114-7.
- Gökçek K, Gökçek A, Demir A, Yıldırım B, Acar E, Alataş ÖD. 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):351-5.
- Türkday Derebey S, Tokgöz HC, Keskin B, Tosun A, Hakgör A, Karagöz A, et al. A New Index for the Prediction of In-Hospital Mortality in Patients with Acute Pulmonary Embolism: The Modified Shock Index. Anatol J Cardiol. 2023;27(5):282-9.
- Upchurch CP, Sanfilippo K, Lew D, Samant M, McDonald R. Association of Shock Index and Variants with Mortality in Acute Pulmonary Embolism. West J Emerg Med. 2025;27(1):137-45.
- Righini M, Nendaz M, Le Gal G, Bounameaux H, Perrier A. Influence of age on the cost-effectiveness of diagnostic strategies for suspected pulmonary embolism. J Thromb Haemost. 2007;5(9):1869-77.
- Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al; ESC Scientific Document Group. 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.