Comparison of Age-Shock Index, Hypoxia-Age-Shock Index, and Pulmonary Embolism Severity Index in Predicting the Prognosis of Patients Presenting to the Emergency Department with a Diagnosis of Pulmonary Embolism

Objective: Pulmonary embolism (PE) is one of the most frequently encountered and potentially fatal acute cardiovascular conditions. Currently, the Pulmonary Embolism Severity Index (PESI) is the most commonly used and well-established scoring system to predict disease severity in PE. The age-shock index (ASI) and hypoxia-age-shock index (HASI), which can be easily calculated from the patients’ vital signs and age, may also be effective in estimating mortality and poor outcomes in pulmonary thromboembolism. This study aims to compare the prognostic and mortality predictive performance of the ASI, HASI, and PESI scores in patients presenting with PE to the emergency department. Materials and Methods: This prospective observational case series included patients older than 18 years who were diagnosed with PE. In all patients suspected of PE at presentation, the ASI and HASI were calculated using vital signs and patient age. Demographic data, comorbidities, shock index (SI), ASI, HASI, and PESI scores were recorded. During follow-up, intensive care unit (ICU) admissions and length of stays, ward length of stays, and mortality at 1 week and 30 days were documented and analysed. Results: A total of 254 patients were included (130 women [51.2%], 124 men [48.8%]). For predicting 1-week mortality, the predictive power of the PESI score (AUC: 0.905 ± 0.02; 95% CI: 0.862–0.938; p < 0.001) was higher compared to HASI (AUC: 0.782 ± 0.04; 95% CI: 0.726–0.831; p < 0.001) and ASI (AUC: 0.748 ± 0.04; 95% CI: 0.690–0.800; p < 0.001). For 30-day mortality, ROC analysis likewise showed that PESI (AUC: 0.915 ± 0.02; 95% CI: 0.873–0.946; p < 0.001) had higher predictive power than HASI (AUC: 0.764 ± 0.04; 95% CI: 0.707–0.815; p < 0.001) and ASI (AUC: 0.729 ± 0.04; 95% CI: 0.670–0.783; p < 0.001). Conclusion: In predicting both 1-week and 30-day mortality in PE patients, the best predictive power was determined PESI, HASI, and ASI consecutevely.