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.

Keywords: Embolia de pulmón; Evaluación del riesgo; Physiological Stress Index; Pulmonary embolism; Reperfusion treatment; Risk assessment; Shock Index; Tratamiento reperfusion.