Shock index as a prognostic value in risk stratification of patients with acute pulmonary embolism

Abstract

Background: Patients with acute pulmonary embolism (PE) presenting with haemodynamic instability have the worst prognosis. The Shock Index (SI) is a sensitive indicator of left ventricular dysfunction. Objective: To assess the value of shock index and echocardiographic abnormalities as predictors of in-hospital complications and mortality in patients with acute pulmonary embolism.Patients&methods: 81 patients who were diagnosed as acute pulmonary embolism were included in this study. Haemodynamic instability defined by shock index ≥1 (HR/systolic blood pressure).Detailed Doppler echocardiography (within 72h of admission)done for all patients. Results: Heart rate, systolic blood pressure and shock index >1 were significantly higher and more frequent in patients with in hospital mortality (P<0.05 each). Patients with in- hospital mortality have statistically significant right ventricular hypokinesia, RV/LV end diastolic diameter >1, right ventricular end diastolic diameter >3, interventricular septal flattening, peak systolic PAP >50 mmHg and E/A ratio <1 (P<0.001, P<0.001, P<0.05, P<0.001, P<0.05, P<0.01 respectively). In multivariate logistic regression analysis, shock index (SI)>1 independent of right ventricular hypokinesia, RV/LV>1 and systolic PAP>50mmHg was associated with significant in-hospital mortality P<0.0001. Conclusion: we can conclude that in pulmonary embolism patients, Shock index > 1 was associated with increased in-hospital mortality independently of other abnormal echocardiographic Doppler parameters and could be helpful in early diagnosis of patients with acute pulmonary embolism who are in need for meticulous observation.