Shock Index and Physiological Stress Index for reestratifying patients with intermediate-high risk pulmonary embolism

Abstract

Objective

Study and Evaluation of Two Scores: Shock Index (SI) and Physiological Stress Index (PSI) as discriminators for proactive treatment (reperfusion before decompensated shock) in a population of intermediate-high risk pulmonary embolism (PE).

Design

Using a database from a retrospective cohort with clinical variables and the outcome variable of “proactive treatment”, a comparison of the populations was conducted. Optimal cut-off for “proactive treatment” points were obtained according to the SI and PSI. Comparisons were carried out based on the cut-off points of both indices.

Setting

Patients admitted to a mixed ICU for PE.

Participants

Patients >18 years old admitted to the ICU with intermediate-high risk PE recruited from January 2015 to October 2022.

Interventions

None.

Main variables of interest

Population comparison and metrics regarding predictive capacity when determining proactive treatment.

Results

SI and PSI independently have a substandard predictive capacity for discriminating patients who may benefit from an early reperfusion therapy. However, their combined use improves detection of sicker intermediate-high risk PE patients (Sensitivity = 0.66) in whom an early reperfusion therapy may improve outcomes (Specificity = 0.9).

Conclusions

The use of the SI and PSI in patients with intermediate-high risk PE could be useful for selecting patients who would benefit from proactive treatment.