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Vol. 48. Issue 6.
Pages 309-316 (June 2024)
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Vol. 48. Issue 6.
Pages 309-316 (June 2024)
Original article
Shock Index and Physiological Stress Index for reestratifying patients with intermediate-high risk pulmonary embolism
Índice de shock e índice de stress fisiológico para la re-estratificación de pacientes con tromboembolismo pulmonar de riesgo intermedio-alto
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Marcos Valiente Fernándeza,
Corresponding author
mvalientefernandez@gmail.com

Corresponding author.
, Amanda Lesmes González de Aledoa, Francisco de Paula Delgado Moyaa, Isaías Martín Badíaa, Elena Álvaro Valientea, Nerea Blanco Otaeguia, Pablo Risco Torresa, Ignacio Saéz de la Fuentea, Silvia Chacón Alvesa, Lidia Orejón Garcíaa, María Sánchez- Bayton Griffithb, José Ángel Sánchez-Izquierdo Rieraa
a Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
b Hospital Universitario de Galdakao-Usansolo
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Tables (2)
Table 1. Comparative table of the different populations according to the predictors (Shock Index, Physiological Stress Index, union and intersection).
Table 2. Confusion matrix.
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Additional material (1)
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:
Pulmonary embolism
Shock Index
Physiological Stress Index
Reperfusion treatment
Risk assessment
Resumen
Objetivo

Valoración de dos scores: Shock Index (SI) y Physiological Stress Index (PSI) como discriminantes de haber recibido tratamiento proactivo (Fibrinolisis o trombectomía) en una población de tromboembolismo pulmonar (TEP) de riesgo intermedio – alto.

Diseño

Sobre una base de datos de una cohorte retrospectiva con variables clínicas se estudió la variable resultado “tratamiento proactivo” en función de los scores SI y PSI. Se obtuvieron los puntos de corte óptimos de haber recibido tratamiento proactivo según el SI y el PSI. Se realizaron comparaciones en función de los puntos de corte de ambos índices.

Ámbito

Pacientes que son ingresados en UCI mixta por TEP.

Pacientes

Pacientes >18 años ingresados en UCI por TEP de riesgo intermedio-alto. Desde enero de 2015 hasta octubre de 2022.

Intervenciones

Ninguna.

Variables de interés principales

Comparación poblacional y métricas en relación a la capacidad predictiva de los scores cuando se determina tratamiento proactivo.

Resultados

Los predictores SI y PSI tienen una capacidad predictiva regular para discriminar los pacientes sometidos a tratamientos proactivos de reperfusión. Su uso combinado mejoran la capacidad de detección de los pacientes más graves (Sensibilidad = 0.66) y que podrían requerir tratamiento (Especificidad = 0.9).

Conclusiones

El uso del SI y del PSI en los pacientes con TEP de riesgo intermedio-alto puede ser útil para seleccionar a pacientes que se beneficiarían de tratamiento proactivo.

Palabras clave:
Embolia de pulmón
Shock Index
Physiological Stress Index
Tratamiento reperfusion
Evaluación del riesgo

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