The role of Shock Index and its derivatives in predicting mortality in patients with upper gastrointestinal bleeding

Abstract

Upper gastrointestinal bleeding (UGIB), a life-threatening emergency, causes significant morbidity, mortality, and healthcare costs. The mortality rate for UGIB is approximately 10%, but this rate rises to 15% in hemodynamically unstable patients. Identifying factors related to mortality and morbidity can help early detection of critical patient groups, guiding initial treatment approaches and patient management for clinicians. This study aims to investigate the performance of the Shock Index (SI) and its derivatives in predicting mortality. In the study, patients diagnosed with UGIB who presented to the Emergency Department (ED) between 2022 and 2024 were analyzed retrospectively. Patients aged 18 and over who were confirmed to have UGIB following internal medicine and/or gastroenterology consultation and were subsequently admitted to the hospital were included in the study. Of the 201 patients included in the study, 112 (55.7%) were male, with a mean age of 70.68±16.617. In-hospital mortality occurred in 17 patients (8.5%), and 30-day mortality was observed in 22 patients (10.9%). When examining the area under the curve (AUC), Age-SI (ASI) showed the best performance in predicting in-hospital mortality (AUC 0.837), followed by Age-Modified Shock Index (AMSI, AUC 0.829), MSI (AUC 0.810), and SI (AUC 0.806). ASI and AMSI can be calculated easily, cost-effectively, quickly, and practically at the time of ED presentation in UGIB patients, aiding in the early identification of critical patient groups and guiding clinicians.