Classification of high-risk with cardiac troponin and shock index in normotensive patients with pulmonary embolism

Abstract

Accurate risk stratification of normotensive patients with acute pulmonary embolism (PE) require further investigation. We aimed to develop a simple model using clinical (shock index) and laboratory findings (cardiac Troponin, echocardiography) to assess the risk of 30-day mortality in normotensive patients with acute PE. In this retrospective study, 489 normotensive patients with acute PE diagnosed objectively. The primary end-point was defined as a all cause 30-day mortality. Shock index was calculated on admission. The primary end-point occurred in 67 (13.7%, 95% CI 10.7-16.8) patients with acute PE. Predictors of complications included elevated cardiac troponin (OR 1.7, 95% CI 1.3-2.2) and shock index (OR 1.3, 95% CI 1.1-1.5) by multivariable analysis. Risk index point was created based on OR. The model identified stages (stage I: 0-1 point, stage II: 2 points and stage III: 3 point) with 30-day mortality rates of 4.3, 19 and 38.6 %, respectively. The shock index and cardiac troponin can be safely used in combination to determine intermediate risk in patients with PE in emergency departmant. The study provided observations that will require prospective validation before the proposed risk score is adopted in clinical practice.

Prognostic value of respiratory index in haemodynamically stable patients with acute pulmonary embolism: The Respiratory Index model study

“…For each patient the following parameters were calculated: the sPESI score (score components are age >80 years, cancer, chronic cardiopulmonary disease, pulse ⩾110 beats per minute, systolic blood pressure <100 mm Hg and arterial oxygen saturation <90%, 4 the shock index (SI) (heart rate to systolic blood pressure ratio) 12 and the novel RI (oxygen saturation in air to respiratory rate ratio). All patients received anticoagulant treatment according to international guidelines.…”

Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases

“…In addition, these investigators postulated that a shock index <1 alone is not a reliable indicator for the treatment of patients in outpatient settings. These authors 24 concluded that an external validation of the present study results in a multicenter cohort is advised to confirm the usefulness of the risk model before using it in clinical practice. In our study, the comparison between SI the day of ICU admission and the day of PE development showed a significant increase of SI the day of PE development (0.85 ± 0.26 vs. 0.95 ± 0.26; P = .027).…”

“…The shock index (SI), defined as heart rate (HR) divided by systolic blood pressure (SBP), should be more than 0.8‐1.0 in patients with shock, with higher values indicating more severe shock than lower values . A shock index (SI) of 1 or more is associated with high mortality . Currently, the shock index is not included in the standard risk assessment of PE.…”

“…14,23 A shock index (SI) of 1 or more is associated with high mortality. 14,23,24 Currently, the shock index is not included in the standard risk assessment of PE. However, in a retrospective study including 489 normotensive-patients with acute PE between 2006 and 2014, Ozsu S et al 24 showed that shock index and cardiac troponin levels can be safely used together to determine intermediate or high risk in patients with PE.…”

“…14,23,24 Currently, the shock index is not included in the standard risk assessment of PE. However, in a retrospective study including 489 normotensive-patients with acute PE between 2006 and 2014, Ozsu S et al 24 showed that shock index and cardiac troponin levels can be safely used together to determine intermediate or high risk in patients with PE. In addition, these investigators postulated that a shock index <1 alone is not a reliable indicator for the treatment of patients in outpatient settings.…”