ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
A New Index for the Prediction of In-Hospital Mortality in Patients with Acute Pulmonary Embolism: The Modified Shock Index [Anatol J Cardiol]
Anatol J Cardiol. 2023; 27(5): 282-289 | DOI: 10.14744/AnatolJCardiol.2023.2530

A New Index for the Prediction of In-Hospital Mortality in Patients with Acute Pulmonary Embolism: The Modified Shock Index

Sevim Türkday Derebey1, Hacer Ceren Tokgöz2, Berhan Keskin2, Ayhan Tosun2, Aykun Hakgör3, Ali Karagöz2, Özgür Yaşar Akbal2, Zübeyde Bayram2, Süleyman Efe2, Cem Doğan2, İbrahim Halil Tanboğa4, Nihal Özdemir2, Cihangir Kaymaz2
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
2Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
3Department of Cardiology, Faculty of Medicine, Medipol University, İstanbul, Turkey
4Department of Biostatistics, Faculty of Medicine, Nisantaşı University, İstanbul, Turkey

Background: Pulmonary embolism severity index, its simplified version, and shock index have been used for risk stratification in acute pulmonary embolism. In this study, we proposed a modification in severity index and evaluated the correlates and prognostic value of modification in severity index in this setting.

Methods: The study group comprised retrospectively evaluated 181 patients with acute pulmonary embolism. Systematic workup including pulmonary embolism severity index, its simplified version, shock index, biomarkers, and echocardiographic and multidetector computed tomography assessments was performed in all patients. Moreover, we calculated modification in severity index by multiplying original shock index (heart rate/systolic blood pressure ratio) and a third component, 1/pulse oxymetric saturation (pSat O2%) ratio. The primary endpoint was defined as all-cause mortality and hemodynamic collapse during the hospital stay.

Results: On the basis of initial risk stratification, ultrasound-assisted thrombolysis, systemic tissue-type plasminogen activator, and unfractionated heparin therapies were utilized in 83 (45.9%), 37 (20.4%), and 61 (33.7%) patients, respectively. The primary end-point occurred in 13 (7.2%) patients. Receiver-operating curve analysis revealed that modification in severity index had the highest area under the curve of 0.739 (0.588-0.890, P =.002) compared with shock index, pulmonary embolism severity index, or its simplified version. The modification in severity index > 0.989 predicted primary endpoint with 73% sensitivity and 54% specificity.

Conclusions: The modification in severity index seems to be a simple, quick, and compre-hensive risk assessment tool for bedside evaluation at initial stratification, in monitoring the clinical benefit from therapies, and decision-making for escalation to other reperfusion strategies in patients with acute pulmonary embolism. However, the prognostic value of modification in severity index needs to be validated with further studies.

Keywords: Pulmonary embolism, risk stratification, thrombolytic therapy

Sevim Türkday Derebey, Hacer Ceren Tokgöz, Berhan Keskin, Ayhan Tosun, Aykun Hakgör, Ali Karagöz, Özgür Yaşar Akbal, Zübeyde Bayram, Süleyman Efe, Cem Doğan, İbrahim Halil Tanboğa, Nihal Özdemir, Cihangir Kaymaz. 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): 282-289

Corresponding Author: Sevim Türkday Derebey
Manuscript Language: English


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Journal Citation Indicator: 0.18
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