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Shock index for outcome and risk stratification in acute pulmonary embolism

Artery Research volume 15, pages 30–35 (2016)Cite this article

Abstract

Introduction

Risk stratification of patients with acute pulmonary embolism (PE) is crucial in deciding appropriate therapy management. Shock index (SI) is rapidly available and a reliable parameter. We aimed to investigate SI for short term outcome in acute PE.

Materials and methods

Data of 182 patients with acute PE were analysed retrospectively. SI was defined as heart rate divided by systolic blood pressure. Logistic regression models were calculated to investigate associations between SI and in-hospital-death, myocardial necrosis and presence of right ventricular dysfunction (RVD) respectively. Moreover ROC curves and cut-off values for SI predicting in-hospital death, myocardial necrosis and RVD were computed.

Results

182 patients (61.5% female, mean age 68.5 ± 15.3 years) with acute PE event were included in the study. 5 patients (2.7%) died an in-hospital death.

Logistic regression models revealed an association between SI and respectively in-hospital death (OR 5.854, 95% CI 1.876–18.274, P = 0.00234), myocardial necrosis (OR 5.043, 95% CI 1.362–18.674, P = 0.0154) and RVD (OR 53.539, 95% CI 6.810–420.914, P = 0.000155).

ROC analysis for SI predicting in-hospital death, myocardial necrosis and RVD revealed an AUC of 0.806, 0.636 and 0.713 respectively with respectively SI cut-off values of 0.89, 0.75 and 0.54.

Conclusions

SI is a significant predictor of in-hospital death, myocardial necrosis and RVD. The effectiveness of SI to predict in-hospital death is high with an optimal cut-off value of 0.89 for differentiation between PE patients with lower and higher risk to die in hospital after acute PE event.

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Authors and Affiliations

  1. Center of Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Karsten Keller, Meike Coldewey & Martin Geyer

  2. Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany

    Karsten Keller & Meike Coldewey

  3. Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany

    Johannes Beule & Wolfgang Dippold

  4. Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz (KKM), Mainz, Germany

    Jörn Oliver Balzer

  5. Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt, Main, Germany

    Jörn Oliver Balzer

Authors
  1. Karsten Keller
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  2. Meike Coldewey
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  3. Martin Geyer
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  4. Johannes Beule
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  5. Jörn Oliver Balzer
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  6. Wolfgang Dippold
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Corresponding author

Correspondence to Karsten Keller.

Additional information

The study was conducted in St. Vincenz and Elisabeth Hospital Mainz (KKM).

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This is an open access article distributed under the CC BY-NC license. https://doi.org/creativecommons.org/licenses/by/4.0/

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Keller, K., Coldewey, M., Geyer, M. et al. Shock index for outcome and risk stratification in acute pulmonary embolism. Artery Res 15, 30–35 (2016). https://doi.org/10.1016/j.artres.2016.05.002

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Keywords

Artery Research

ISSN: 1876-4401

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