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

Abstract

ObjectiveStudy 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). DesignUsing 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. SettingPatients admitted to a mixed ICU for PE. ParticipantsPatients >18 years old admitted to the ICU with intermediate-high risk PE recruited from January 2015 to October 2022. InterventionsNone. Main variables of interestPopulation comparison and metrics regarding predictive capacity when determining proactive treatment. ResultsSI 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). ConclusionsThe 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.