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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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 AGİT OLGUN, sevinc olgun, baran olgun, ugur isik, fatma ak, mehmet yildiz, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7566851/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Pulmonary Embolism emergency department prognosis mortality Hypoxia-age-shock index Age-shock index Pulmonary Embolism Severity Index Figures Figure 1 Figure 2 1. Introduction In severe clinical conditions such as pulmonary embolism (PE), various clinical scores are used to predict the risk of mortality. The PESI (Pulmonary Embolism Severity Index) score is a scoring system that has been used safely in the literature for an extended period to predict the short-term mortality risk in PE patients by evaluating parameters such as patient age, comorbidities, vital signs, and laboratory results [ 1 ]. In recent years, new indices have been developed in this field. The age-shock index (ASI) helps to determine clinical risk by correlating the patient’s age with haemodynamic parameters such as pulse and blood pressure [ 2 ]. In addition to these parameters, the hypoxia-age-shock index (HASI) also evaluates the patient’s oxygen saturation and examines the effect of hypoxia on clinical outcomes [ 3 , 4 ]. The ASI (age x heart rate/systolic blood pressure) and HASI (Age x Shock Index/SpO2) are introduced parameters in the literature, and studies in this field are quite limited [ 5 ]. Although HASI and ASI scores have been applied in the diagnosis of other diseases, their use in patients with pulmonary embolism remains limited. Unlike the PESI score, these indices can be calculated rapidly using only vital signs, which provides a significant advantage in emergency department settings where time is critical. Therefore, our study represents a pioneering investigation that evaluates the effectiveness of these indices in predicting mortality in PE and contributes to the limited body of literature in this field. 2. Methods Our study is a prospective observational case series study. Our research was initiated after ethics committee approval (11.05.2023-2562) and was performed according to the Declaration of Helsinki and good clinical practice. Between 01.06.2023 and 01.12.2024, 254 patients over 18 years of age with a confirmed diagnosis of PE who presented to the emergency department between these dates were included in the study. In addition to patients’ age and gender characteristic comorbidities, the following were recorded in the standard data collection form vitals, shock index (SI), ASI, HASI, PESI core, presence and duration of intensive care unit (ICU) hospitalisation, duration of ward stay, 1-week survival, and 30-day survival. Deaths occurring during hospitalisation were identified through the hospital information system and epicrisis. For patients who were referred to another hospital, the relevant hospital was contacted, and prognosis information about the patients was obtained through epicrises. In addition, 1-week and 30-day mortality follow-up were performed and recorded through the Public Health Directorate Death Notification System. The SI, ASI, HASI, and PESI scores were calculated, and 1-week and 30-day mortality were compared in all patients. Patients with unclear diagnosis, patients who could not be followed up with, patients with missing data in the file, and patients under 18 years of age were excluded from the study. Statistical Analysis SPSS 22.0 package programme (SPSS Inc. Chicago, Illinois, USA) was used for statistical evaluation of the data obtained in the study. Continuous data were summarised as mean and standard deviation, whereas categorical data were summarised as number and percentage. Categorical data were compared via a chi-square test. The Kolmogorov–Smirnov test was used to determine whether continuous variables were normally distributed. Continuous variables were shown as mean and standard deviation. In the evaluations made with histograms, a Student’s t-test was used for two group comparisons when the variables were normally distributed, and a Mann–Whitney U test was used when the variables were not normally distributed. Descriptive statistics were expressed as mean ± standard deviation (SD) and median (interquartile range, IQR). The accuracy of hypoxia wet SI, wet SI, and PESI scores in predicting 1-week and 30-day mortality was investigated using receiver operating characteristic (ROC) curve analysis calculated with MedCalc version 23.1.6 (Acacialaan 22 8400 Ostend Belgium) statistical programme. In the presence of significant cut-off values, the sensitivity, specificity, and values of these cut-off values were calculated. In evaluating the area under the curve, a type 1 error level below 5% was interpreted as a statistically significant diagnostic value of the test. P < 0.05 was taken as the statistical significance level. 3. Results A total of 254 patients who were admitted to the emergency medicine clinic of Adana City Training and Research Hospital between 01.06.2023 and 01.12.2024 and diagnosed with PE during follow-up were included in the study. Although 51.2% (n = 130) of the patients were female, 48.8% (n = 124) were male. The mean age of male patients was 63.98 ± 15.36 years, whereas the mean age of female patients was 66.72 ± 16.44 years. The most common comorbidity was hypertension with a rate of 58.7% (n = 149). Chronic lung disease was present in 17.7% (n = 45) of the cases. Malignancy was diagnosed in 29.5% (n = 75) of the cases. The incidence of 1-week and 30-day mortality was statistically significantly higher in patients with asthma (p = 0.002) and malignancy (p < 0.001). Demographic data are summarised in Table 1 . Table 1 Demographic data Total patients (n = 254) Discharged patients (n = 205) Mortal patients (n = 49) P value Age (years) mean ± SD 65,38 ± 15,95 64,77 ± 15,58 67,92 ± 17,36 0,158 Gender Famale Male 130 124 106(%51,70) 99(%48,29) 24(%49) 25(%51) 0,427 Comorbidities Hypertension Coronary artery disease Diabetes mellitus Malignancy Chronic lung disease Cerebrovascular disease Chronic kidney disease Heart valve disease Heart failure 149(%58,7) 64(%25,2) 62(%24,4) 75(%29,5) 45(%17,7) 11(%4,3) 37(%14,6) 9(%3,5) 36(%14,2) 120(%58,53) 54(%26,34) 51(%24,87) 46(%22,44) 29(%14,14) 8(%3,90) 28(%13,65) 9(%4,39) 27(%13,17) 29(%59,18) 10(20,40) 11(%22,44) 29(%59,18) 16(%32,65) 3(%6,12) 9(%18,36) 0(%0) 9(%18,36) 0,934 0,390 0,722 0,000 0,002 0,493 0,401 0,135 0,349 When the outcome of the patients in the emergency department was evaluated, 183 (72.04%) patients were hospitalised in the ICU, 64 (25.19%) were hospitalised in the ward, and seven (2.75%) were exited in the emergency department. The mean duration of ICU hospitalisation was 4.92 ± 5, whereas the mean duration of ward hospitalisation was 5.73 ± 4.88. When we evaluated the 1-week survival of the patients, 33 (13%) were exited, whereas 221 (87%) survived. When the 30-day mortality was evaluated, 49 (19.3%) patients were exited and 205 (80.7%) were discharged. The comparison of 1-week and 30-day mortality is summarised in Table 2 . Table 2 The comparison of 1-week and 30-day mortality Survival Pulmonary embolism severity index mean ± SD (P value) Age-shock index mean ± SD (P value) Hypoxia-age-shock index mean ± SD (P value) 1 week Exitus Survivor 191,66 ± 49,45 104,42 ± 42,90 (P < 0,001) 84,96 ± 37,90 56,78 ± 21,71 (P < 0,005) 1,08 ± 0,60 0,62 ± 0,26 (P < 0,005) 30 days Exitus Survivor 185,38 ± 49,01 99,12 ± 37,84 (P < 0,001) 80,44 ± 35,13 55,66 ± 20,88 (P < 0,005) 1,00 ± 0,54 0,60 ± 0,24 (P < 0,005) The mean value of the PESI score used for prognostic evaluation of the patients was 115.76 ± 52.66. The minimum value was 28, and the maximum value was 278. The mean value of those who were mortal in the first 1 week was 191.66 ± 49.45, whereas the mean value of those who survived was 104.42 ± 42.90. The PESI score was statistically significantly higher in patients with a mortal course (P < 0.001). When we looked at 30-day mortality, the mean of the mortal patients was 185.38 ± 49.01, whereas the mean of the survivors was 99.12 ± 37.84, which constituted a significant difference (P < 0.001). The mean value of the ASI, another index we compared, was 60.44 ± 26.11 in all patients. The minimum value was 15.4, and the maximum value was 210.16. The mean value of the patients who were mortal in the first 1 week was 84.96 ± 37.90, whereas the mean value of the survivors was 56.78 ± 21.71. The ASI score was statistically significantly higher in the mortal patients (P < 0.005). When we looked at 30-day mortality, the mean of the mortal patients was 80.44 ± 35.13, whereas the mean of the survivors was 55.66 ± 20.88, and there was a statistically significant difference in the mortal patients (P < 0.005). ROC curves of the scores for 1-week mortality prediction are shown in Fig. 1 The mean value of our last index, HASI, was 0.68 ± 0.36 in all patients. The minimum value was 0.17, and the maximum value was 3.28. The mean value of the patients who were mortal in the first 1 week was 1.08 ± 0.60, whereas the mean value of the survivors was 0.62 ± 0.26. The HASI score was statistically significantly higher in patients with a mortal course (P < 0.005). When we looked at 30-day mortality, the mean of the mortal patients was 1.00 ± 0.54, whereas the mean of the survivors was 0.60 ± 0.24, and the HASI score was statistically significantly higher in the mortal patients (P < 0.005). When PESI risk classes were analysed for 1-week and 30-day mortality, it was observed that mortality was higher in patients in PESI 5 class, whereas the discharge rate was statistically significantly higher in other patient groups (PESI 1, 2, 3, 4) (p < 0.001). The 1-week and 30-day survival rates according to PESI score classification are shown in Table 3 . Table 3 The 1-week and 30-day survival rates according to PESI score classification Pulmonary embolism severity index (PESI) 1 week survival Exitus 1 week survival Survivor 30-day survival Exitus 30-day survival Survivor Total (%) P value PESI score Class I: 126 0 0 1 2 30 34 50 52 34 51 0 0 3 4 42 34 50 50 32 39 34(13,4) 50(19,7) 53(20,9) 36(14,2) 81(31,9) P < 0,001 When we looked at the first hospitalisations from the emergency department, the mean value of the HASI was 0.74 ± 0.32 in patients hospitalised in the ICU and 0.45 ± 0.15 in patients hospitalised only in the ward. The HASI value of the patients hospitalised in the ICU was statistically significantly higher (p < 0.001). The mean value of the PESI was 127.39 ± 51.83 in patients hospitalised in the ICU and 75.73 ± 27.53 in patients hospitalised only in the ward. The PESI score value of the patients hospitalised in the ICU was statistically significantly higher (p < 0.001). The mean ASI was 65.32 ± 24.37 in patients hospitalised in the ICU and 42.96 ± 13.65 in patients hospitalised only in the ward. The ASI value of the patients hospitalised in the ICU was statistically significantly higher (p < 0.001). Table 15 shows the correlation of the HASI, ASI, and PESI with the days of hospitalisation in the ward and the days of hospitalisation in the ICU. As shown in Table 15, we observed there was a positive correlation between the high PESI score and the duration of ICU stay, and this correlation created a significant difference (p < 0.001). According to the ROC analyses of the patients, the predictive power of all three indices for mortality was found to be statistically significant. In the comparisons made, it was determined that the highest predictive power among the predictive values determined by the area under the curve was in the PESI value (AUC:0.905 ± 0.02, 95% CI 0.862–0.938, P < 0.001). When the cut-off value of the PESI score was 126, the Youden index J value was 0.6874 with a sensitivity of 77.83% and a specificity of 90.91%. After the PESI score, the highest AUC value was the HASI (AUC: 0.782 ± 0.04, 95% CI 0.726–0.831, p < 0.001), and if the cut-off value of 0.68 was taken as the power to predict mortality, the Youden index J value of 0.4576 was found to have a sensitivity of 66.97% and a specificity of 78.79%. The index with the lowest AUC value was the ASI (AUC: 0.748 ± 0.04, 95% CI 0.690–0.800, P < 0.001), and when we took the cut-off value of 73.3 as the power to predict mortality, the Youden index J value was 0.4205 with a sensitivity of 81.45% and a specificity of 60.61%. When we compared the indices among themselves, the difference in AUC between the HASI and the SI was 0.033 ± 0.013, the 95% confidence interval was 0.00781–0.0588, and the difference between them was significant in predicting mortality (p = 0.0105). When we compared the ASI with the PESI, the AUC difference was 0.157 ± 0.042, the 95% confidence interval (CI) was 0.0734-0.240, and the difference between them was significant in predicting mortality (p < 0.001). When we compared hypoxia-age-shock and PESI, the difference in AUC was 0.1230 ± 0.039, the 95% CI was 0.0467-0.200, and the difference between them was significant in predicting mortality (p < 0.001). ROC curves of the scores for one-week mortality prediction are given in Fig. 1 . According to the ROC analyses of the patients, the predictive power of all three indices for mortality was found to be statistically significant. In the comparisons made, it was determined that the highest predictive power among the predictive values determined by the area under the curve was determined in the PESI value (AUC: 0.915 ± 0.02, 95% CI 0.873–0.946 P < 0.001). When the cut-off value of PESI score was 122, the Youden index J value was 0.6989 with a sensitivity of 78.05% and a specificity of 91.84%. After the PESI score, the highest AUC value was the HASI (AUC:0.764 ± 0.04, 95% CI 0.707–0.815, p < 0.001), and the Youden index J value was 0.4166 with a sensitivity of 92.68% and a specificity of 48.98% when the cut-off value of 0.95 was taken for the power to predict mortality. In this ROC curve, the index with the lowest AUC value was the ASI (AUC: 0.729 ± 0.04, 95% CI 0.670–0.783, P < 0.001), and when we took the cut-off value of 73.3 in the power to predict mortality, the Youden index J value was 0.3852, with a sensitivity of 83.41% and a specificity of 55.10%. When we compared the indices among themselves, the difference in AUC between the HASI and the SI was 0.033 ± 0.013, the 95% CI was 0.00781–0.0588, and the difference between them was significant in predicting mortality (p = 0.0105). When we compared the ASI with the PESI, the AUC difference was 0.157 ± 0.042, the 95% CI was 0.0734-0.240, and the difference between them was significant in predicting mortality (p < 0.001). When we compared the HASI and PESI, the difference in AUC was 0.1230 ± 0.039, the 95% confidence interval was 0.0467-0.200, and the difference between them was significant in predicting mortality (p < 0.001). ROC curves of the scores for 30-day mortality prediction are shown in Fig. 2 . 4. Discussion PESI scoring includes demographic characteristics such as age and gender, comorbidities such as malignancy, heart failure, chronic lung disease, vital signs such as pulse rate, blood pressure, respiratory rate, oxygen saturation, body temperature, and clinical findings such as altered consciousness. In a study conducted by Tanaka H et al. in 2024, mortality was 5 times higher in patients with a PESI score above 86 [ 6 ]. Brown T et al. (2025) determined that the 1-year mortality was < 1 in patients with a low PESI score (≤ 65) [ 7 ]. This scoring is used throughout the world to indicate disease severity and predict mortality in PE[ 8 ]. In a 2005 study, Aujesky et al. found male gender and age to be an independent risk factor in predicting mortality; therefore, male gender and age were included as poor prognostic factors in PESI scoring[ 1 ]. Similarly, Hoskin et al. (2020) observed that male gender increased mortality [ 8 ]. On the same subject, Tanabe et al. found mortality to be higher in the female gender in contrast to other studies [ 9 ]. In our study, we did not determine any significant difference between male and female patients in terms of mortality. In our study, we found that the presence of asthma increased mortalityAsthma is one of the chronic inflammatory diseases associated with procoagulant and antifibrinolytic activities in the airways. The pathophysiology of coagulation in asthmatic patients is activated by increased tissue factor expression in various cell types, decreased activity of the anticoagulant protein C system, and inhibition of fibrinolysis through overproduction of plasminogen activator inhibitor type 1 (PAI1). Therefore, asthma may be a risk factor for PE and can increase mortality, especially in patients with severe disease conditions that include frequent exacerbations.In our study, similar to the literature, [ 10 – 12 ] the presence of asthma diagnosis significantly increased patients’ PE mortality. In our study, 34 patients were in PESI Class I, and 50 were in PESI Class II. No death was observed in these few patients in both classes. The patient population was not homogenously distributed in PESI classes, and the high-risk patient group was predominant in our study. In the PESI Class III group, the 1-week mortality rate was 1.88%, and the 30-day mortality rate was 5.66%, which is close to the expected mortality rate in the PESI derivation and validation study. In PESI Class IV, the 1-week mortality rate was 5.55%, and the 30-day mortality rate was 11.11%. In PESI Class V, which had the highest number of patients and the highest mortality rate in our study, the 1-week mortality rate was 37.03%, and the 30-day mortality rate was 51.85%. In the study published by Drahomir Aujesky et al. in 2005, the expected mortality rates in Class IV and V were 4-11.4% and 10-24.5%[ 1 ]. In our study, we observed a higher mortality rate than the mortality rates in the literature, especially in Classes IV and V. This may be due to the high number of patients with advanced age and malignancy and the fact that the life expectancy of patients with malignancy is not long. In our study, we determined that the sensitivity and specificity were 77.83% and 90.91%, respectively, when the cut-off value of PESI score was 126). Yu Zhou et al. (2012) found that the sensitivity of the PESI score in predicting mortality was 90% and that the specificity was 41% [ 13 ]. In comparing sPESI with PESI, Wei-Ying Jen et al. determined the PESI sensitivity to be 81.8% and the specificity to be 36.1%; however, for the RIETE score, E. Jaquet et al. found the sensitivity of PESI to be 96% and the specificity to be 36% [ 14 , 15 ] investigated the usability of the ASI and HASI first introduced to the literature in 2022 by Chien-Chieh Hsieh et al., assessing 262 patients diagnosed with COVID-19 on patients with PE. In the study conducted in 2022, the effect of the ASI on mortality was AUC: 0.773 (CI 95% 0.725–0.821), and its sensitivity was 93.33%, with a specificity of 56.85% when the cut-off point was 44.35 [ 16 ]. In our study, AUC: 0.729 (95% CI 0.670–0.783) was found to have a sensitivity of 83.41% and specificity of 55.10% when we took a cut-off value of 73.3 in the power to predict mortality. When we looked at the effect of the HASI on mortality in the same study, AUC: 0.774 (95% CI 0.716–0.823), when we took a cut-off value of 0.48, its sensitivity was 93.33%, and its specificity was 58.92%. In our study, the AUC of the HASI was 0.764 (95% CI 0.707–0.815), its sensitivity was 92.68%, and its specificity was 48.98% when the cut-off value was 0.95. This shows that the ASI and HASI can be used significantly to predict PE mortality. Limitations One limitation of our research was that it was single-centre study, and the ASI and HASI were measured only at the time of admission. In future studies, more than one centre can be included, the number of patients can be increased, and repeated measurements of the ASI and HASI can be recorded. 5. Conclusion In patients with pulmonary embolism, the order of predictive power for 1-week and 30-day mortality was PESI, HASI, and ASI. Although HASI and ASI can be calculated more rapidly than PESI, their predictive power for mortality in our study was found to be close to that of PESI. Therefore, validation through multicentre prospective studies would provide important contributions to the literature. Declarations All authors declare that they have no conflict of interest. Funding: None to declare References Hassine M, Kallala MY, Mahjoub M, Boussaada M, Bouchahda N, Gamra H (2023) Pulmonary embolism: the Pulmonary Embolism Severity Index (PESI) score and mortality predictors. Pan Afr Med J 45:48 Gökçek K, Gökçek A, Demir A, Yıldırım B, Acar E, Alataş ÖD (2022) In-hospital mortality of acute pulmonary embolism: Predictive value of shock index, modified shock index, and age shock index scores. Med Clin (Barc) 158(8):351–355 Shen Y, Wan C, Yang M et al (2021) The hypoxia-age-shock index as a predictive tool in emergency medicine. 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J Thromb Haemostasis July 16(7):1313–1320 Jen WY, Jeon YS, Kojodjojo P, Lee EHE, Lee YH, Ren YP, Tan TJS, Song Y, Zhang T, Teo L, Feng M, Chee YL (2018) A New Model for Risk Stratification of Patients With Acute Pulmonary Embolism. Clin Appl Thromb Haemost 24(9):277S–284S Hsieh CC, Liu CY, Tsai KC, Jaw FS, Chen J (2023) The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients. Am J Emerg Med 65:65–70 Supplementary Files renamed216c8.docx renamedcda92.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7566851","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530197717,"identity":"c059da0f-d086-4092-9b9d-89145e04e9bc","order_by":0,"name":"AGİT 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18:13:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7566851/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7566851/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94665599,"identity":"131e28d8-ae95-4e4b-885d-bbc433ad18bf","added_by":"auto","created_at":"2025-10-29 12:29:05","extension":"xml","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15289,"visible":true,"origin":"","legend":"","description":"","filename":"iaemIAEMD2501418.xml","url":"https://assets-eu.researchsquare.com/files/rs-7566851/v1/a57b4e8feb30a620924019f1.xml"},{"id":94672645,"identity":"4a02ffd4-5df8-48b4-9356-4ec314a3fb28","added_by":"auto","created_at":"2025-10-29 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12:29:05","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74095,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7566851/v1/afeb227cbe9c7180970d3a18.html"},{"id":94672674,"identity":"5bce1a4e-92a6-4140-8bab-63f4b920f5b1","added_by":"auto","created_at":"2025-10-29 13:40:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19209,"visible":true,"origin":"","legend":"\u003cp\u003eROC analysis of the effect of age shock index, hypoxia age shock index and PESI score on 1-week mortality\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7566851/v1/c48dff2e4ed1154ff1f3ccc4.png"},{"id":94665595,"identity":"5e48e3ec-faca-421b-9cf8-1a6961e24a20","added_by":"auto","created_at":"2025-10-29 12:29:05","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":248644,"visible":true,"origin":"","legend":"\u003cp\u003eROC analysis of the effect of age shock index, hypoxia age shock index and PESI score on 30-day mortality\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7566851/v1/fd71ba020991e63c06f914b5.jpeg"},{"id":97668446,"identity":"b06dc1a2-31d2-4ab7-a956-575718d89f53","added_by":"auto","created_at":"2025-12-08 09:25:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":886888,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7566851/v1/36d2dc11-ef2a-46a5-bcd6-66e5059b086d.pdf"},{"id":94672733,"identity":"02161769-3800-43f0-b46c-549c1c7fb56c","added_by":"auto","created_at":"2025-10-29 13:40:54","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":35062,"visible":true,"origin":"","legend":"","description":"","filename":"renamed216c8.docx","url":"https://assets-eu.researchsquare.com/files/rs-7566851/v1/21662dbf17c2205112dc1373.docx"},{"id":94665602,"identity":"ca871356-b6fa-41f1-b022-f6263f7c2e7e","added_by":"auto","created_at":"2025-10-29 12:29:05","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":16036755,"visible":true,"origin":"","legend":"","description":"","filename":"renamedcda92.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7566851/v1/79a8649165274b3878239aa3.pdf"}],"financialInterests":"","formattedTitle":"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","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn severe clinical conditions such as pulmonary embolism (PE), various clinical scores are used to predict the risk of mortality. The PESI (Pulmonary Embolism Severity Index) score is a scoring system that has been used safely in the literature for an extended period to predict the short-term mortality risk in PE patients by evaluating parameters such as patient age, comorbidities, vital signs, and laboratory results [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, new indices have been developed in this field. The age-shock index (ASI) helps to determine clinical risk by correlating the patient\u0026rsquo;s age with haemodynamic parameters such as pulse and blood pressure [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In addition to these parameters, the hypoxia-age-shock index (HASI) also evaluates the patient\u0026rsquo;s oxygen saturation and examines the effect of hypoxia on clinical outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The ASI (age x heart rate/systolic blood pressure) and HASI (Age x Shock Index/SpO2) are introduced parameters in the literature, and studies in this field are quite limited [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although HASI and ASI scores have been applied in the diagnosis of other diseases, their use in patients with pulmonary embolism remains limited. Unlike the PESI score, these indices can be calculated rapidly using only vital signs, which provides a significant advantage in emergency department settings where time is critical. Therefore, our study represents a pioneering investigation that evaluates the effectiveness of these indices in predicting mortality in PE and contributes to the limited body of literature in this field.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eOur study is a prospective observational case series study. Our research was initiated after ethics committee approval (11.05.2023-2562) and was performed according to the Declaration of Helsinki and good clinical practice.\u003c/p\u003e\u003cp\u003eBetween 01.06.2023 and 01.12.2024, 254 patients over 18 years of age with a confirmed diagnosis of PE who presented to the emergency department between these dates were included in the study.\u003c/p\u003e\u003cp\u003eIn addition to patients\u0026rsquo; age and gender characteristic comorbidities, the following were recorded in the standard data collection form vitals, shock index (SI), ASI, HASI, PESI core, presence and duration of intensive care unit (ICU) hospitalisation, duration of ward stay, 1-week survival, and 30-day survival. Deaths occurring during hospitalisation were identified through the hospital information system and epicrisis. For patients who were referred to another hospital, the relevant hospital was contacted, and prognosis information about the patients was obtained through epicrises. In addition, 1-week and 30-day mortality follow-up were performed and recorded through the Public Health Directorate Death Notification System.\u003c/p\u003e\u003cp\u003eThe SI, ASI, HASI, and PESI scores were calculated, and 1-week and 30-day mortality were compared in all patients. Patients with unclear diagnosis, patients who could not be followed up with, patients with missing data in the file, and patients under 18 years of age were excluded from the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003e SPSS 22.0 package programme (SPSS Inc. Chicago, Illinois, USA) was used for statistical evaluation of the data obtained in the study. Continuous data were summarised as mean and standard deviation, whereas categorical data were summarised as number and percentage. Categorical data were compared via a chi-square test. The Kolmogorov\u0026ndash;Smirnov test was used to determine whether continuous variables were normally distributed. Continuous variables were shown as mean and standard deviation. In the evaluations made with histograms, a Student\u0026rsquo;s t-test was used for two group comparisons when the variables were normally distributed, and a Mann\u0026ndash;Whitney U test was used when the variables were not normally distributed. Descriptive statistics were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and median (interquartile range, IQR).\u003c/p\u003e\u003cp\u003eThe accuracy of hypoxia wet SI, wet SI, and PESI scores in predicting 1-week and 30-day mortality was investigated using receiver operating characteristic (ROC) curve analysis calculated with MedCalc version 23.1.6 (Acacialaan 22 8400 Ostend Belgium) statistical programme. In the presence of significant cut-off values, the sensitivity, specificity, and values of these cut-off values were calculated. In evaluating the area under the curve, a type 1 error level below 5% was interpreted as a statistically significant diagnostic value of the test. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as the statistical significance level.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 254 patients who were admitted to the emergency medicine clinic of Adana City Training and Research Hospital between 01.06.2023 and 01.12.2024 and diagnosed with PE during follow-up were included in the study. Although 51.2% (n\u0026thinsp;=\u0026thinsp;130) of the patients were female, 48.8% (n\u0026thinsp;=\u0026thinsp;124) were male. The mean age of male patients was 63.98\u0026thinsp;\u0026plusmn;\u0026thinsp;15.36 years, whereas the mean age of female patients was 66.72\u0026thinsp;\u0026plusmn;\u0026thinsp;16.44 years.\u003c/p\u003e\n\u003cp\u003eThe most common comorbidity was hypertension with a rate of 58.7% (n\u0026thinsp;=\u0026thinsp;149). Chronic lung disease was present in 17.7% (n\u0026thinsp;=\u0026thinsp;45) of the cases. Malignancy was diagnosed in 29.5% (n\u0026thinsp;=\u0026thinsp;75) of the cases. The incidence of 1-week and 30-day mortality was statistically significantly higher in patients with asthma (p\u0026thinsp;=\u0026thinsp;0.002) and malignancy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Demographic data are summarised in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic data\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal patients\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;254)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDischarged patients\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;205)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMortal patients\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years) mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e65,38\u0026thinsp;\u0026plusmn;\u0026thinsp;15,95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e64,77\u0026thinsp;\u0026plusmn;\u0026thinsp;15,58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e67,92\u0026thinsp;\u0026plusmn;\u0026thinsp;17,36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,158\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003eFamale\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e130\u003c/p\u003e\n\u003cp\u003e124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e106(%51,70)\u003c/p\u003e\n\u003cp\u003e99(%48,29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24(%49)\u003c/p\u003e\n\u003cp\u003e25(%51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,427\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComorbidities\u003c/p\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003cp\u003eCoronary artery disease\u003c/p\u003e\n\u003cp\u003eDiabetes mellitus\u003c/p\u003e\n\u003cp\u003eMalignancy\u003c/p\u003e\n\u003cp\u003eChronic lung disease\u003c/p\u003e\n\u003cp\u003eCerebrovascular disease\u003c/p\u003e\n\u003cp\u003eChronic kidney disease\u003c/p\u003e\n\u003cp\u003eHeart valve disease\u003c/p\u003e\n\u003cp\u003eHeart failure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e149(%58,7)\u003c/p\u003e\n\u003cp\u003e64(%25,2)\u003c/p\u003e\n\u003cp\u003e62(%24,4)\u003c/p\u003e\n\u003cp\u003e75(%29,5)\u003c/p\u003e\n\u003cp\u003e45(%17,7)\u003c/p\u003e\n\u003cp\u003e11(%4,3)\u003c/p\u003e\n\u003cp\u003e37(%14,6)\u003c/p\u003e\n\u003cp\u003e9(%3,5)\u003c/p\u003e\n\u003cp\u003e36(%14,2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e120(%58,53)\u003c/p\u003e\n\u003cp\u003e54(%26,34)\u003c/p\u003e\n\u003cp\u003e51(%24,87)\u003c/p\u003e\n\u003cp\u003e46(%22,44)\u003c/p\u003e\n\u003cp\u003e29(%14,14)\u003c/p\u003e\n\u003cp\u003e8(%3,90)\u003c/p\u003e\n\u003cp\u003e28(%13,65)\u003c/p\u003e\n\u003cp\u003e9(%4,39)\u003c/p\u003e\n\u003cp\u003e27(%13,17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29(%59,18)\u003c/p\u003e\n\u003cp\u003e10(20,40)\u003c/p\u003e\n\u003cp\u003e11(%22,44)\u003c/p\u003e\n\u003cp\u003e29(%59,18)\u003c/p\u003e\n\u003cp\u003e16(%32,65)\u003c/p\u003e\n\u003cp\u003e3(%6,12)\u003c/p\u003e\n\u003cp\u003e9(%18,36)\u003c/p\u003e\n\u003cp\u003e0(%0)\u003c/p\u003e\n\u003cp\u003e9(%18,36)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,934\u003c/p\u003e\n\u003cp\u003e0,390\u003c/p\u003e\n\u003cp\u003e0,722\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e0,000\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e0,002\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e0,493\u003c/p\u003e\n\u003cp\u003e0,401\u003c/p\u003e\n\u003cp\u003e0,135\u003c/p\u003e\n\u003cp\u003e0,349\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eWhen the outcome of the patients in the emergency department was evaluated, 183 (72.04%) patients were hospitalised in the ICU, 64 (25.19%) were hospitalised in the ward, and seven (2.75%) were exited in the emergency department. The mean duration of ICU hospitalisation was 4.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5, whereas the mean duration of ward hospitalisation was 5.73\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88.\u003c/p\u003e\n\u003cp\u003eWhen we evaluated the 1-week survival of the patients, 33 (13%) were exited, whereas 221 (87%) survived. When the 30-day mortality was evaluated, 49 (19.3%) patients were exited and 205 (80.7%) were discharged. The comparison of 1-week and 30-day mortality is summarised in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe comparison of 1-week and 30-day mortality\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSurvival\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePulmonary embolism severity index\u003c/p\u003e\n\u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003cp\u003e(P value)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAge-shock index\u003c/p\u003e\n\u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003cp\u003e(P value)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHypoxia-age-shock index\u003c/p\u003e\n\u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003cp\u003e(P value)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 week\u003c/p\u003e\n\u003cp\u003eExitus\u003c/p\u003e\n\u003cp\u003eSurvivor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e191,66\u0026thinsp;\u0026plusmn;\u0026thinsp;49,45\u003c/p\u003e\n\u003cp\u003e104,42\u0026thinsp;\u0026plusmn;\u0026thinsp;42,90\u003c/p\u003e\n\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0,001)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84,96\u0026thinsp;\u0026plusmn;\u0026thinsp;37,90\u003c/p\u003e\n\u003cp\u003e56,78\u0026thinsp;\u0026plusmn;\u0026thinsp;21,71\u003c/p\u003e\n\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0,005)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,08\u0026thinsp;\u0026plusmn;\u0026thinsp;0,60\u003c/p\u003e\n\u003cp\u003e0,62\u0026thinsp;\u0026plusmn;\u0026thinsp;0,26\u003c/p\u003e\n\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0,005)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 days\u003c/p\u003e\n\u003cp\u003eExitus\u003c/p\u003e\n\u003cp\u003eSurvivor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e185,38\u0026thinsp;\u0026plusmn;\u0026thinsp;49,01\u003c/p\u003e\n\u003cp\u003e99,12\u0026thinsp;\u0026plusmn;\u0026thinsp;37,84\u003c/p\u003e\n\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0,001)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80,44\u0026thinsp;\u0026plusmn;\u0026thinsp;35,13\u003c/p\u003e\n\u003cp\u003e55,66\u0026thinsp;\u0026plusmn;\u0026thinsp;20,88\u003c/p\u003e\n\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0,005)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,00\u0026thinsp;\u0026plusmn;\u0026thinsp;0,54\u003c/p\u003e\n\u003cp\u003e0,60\u0026thinsp;\u0026plusmn;\u0026thinsp;0,24\u003c/p\u003e\n\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0,005)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean value of the PESI score used for prognostic evaluation of the patients was 115.76\u0026thinsp;\u0026plusmn;\u0026thinsp;52.66. The minimum value was 28, and the maximum value was 278. The mean value of those who were mortal in the first 1 week was 191.66\u0026thinsp;\u0026plusmn;\u0026thinsp;49.45, whereas the mean value of those who survived was 104.42\u0026thinsp;\u0026plusmn;\u0026thinsp;42.90. The PESI score was statistically significantly higher in patients with a mortal course (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When we looked at 30-day mortality, the mean of the mortal patients was 185.38\u0026thinsp;\u0026plusmn;\u0026thinsp;49.01, whereas the mean of the survivors was 99.12\u0026thinsp;\u0026plusmn;\u0026thinsp;37.84, which constituted a significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eThe mean value of the ASI, another index we compared, was 60.44\u0026thinsp;\u0026plusmn;\u0026thinsp;26.11 in all patients. The minimum value was 15.4, and the maximum value was 210.16. The mean value of the patients who were mortal in the first 1 week was 84.96\u0026thinsp;\u0026plusmn;\u0026thinsp;37.90, whereas the mean value of the survivors was 56.78\u0026thinsp;\u0026plusmn;\u0026thinsp;21.71. The ASI score was statistically significantly higher in the mortal patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005). When we looked at 30-day mortality, the mean of the mortal patients was 80.44\u0026thinsp;\u0026plusmn;\u0026thinsp;35.13, whereas the mean of the survivors was 55.66\u0026thinsp;\u0026plusmn;\u0026thinsp;20.88, and there was a statistically significant difference in the mortal patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005). ROC curves of the scores for 1-week mortality prediction are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe mean value of our last index, HASI, was 0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36 in all patients. The minimum value was 0.17, and the maximum value was 3.28. The mean value of the patients who were mortal in the first 1 week was 1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60, whereas the mean value of the survivors was 0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26. The HASI score was statistically significantly higher in patients with a mortal course (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005). When we looked at 30-day mortality, the mean of the mortal patients was 1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54, whereas the mean of the survivors was 0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24, and the HASI score was statistically significantly higher in the mortal patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005).\u003c/p\u003e\n\u003cp\u003eWhen PESI risk classes were analysed for 1-week and 30-day mortality, it was observed that mortality was higher in patients in PESI 5 class, whereas the discharge rate was statistically significantly higher in other patient groups (PESI 1, 2, 3, 4) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The 1-week and 30-day survival rates according to PESI score classification are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe 1-week and 30-day survival rates according to PESI score classification\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePulmonary embolism severity index (PESI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1 week survival\u003c/p\u003e\n\u003cp\u003eExitus\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1 week survival\u003c/p\u003e\n\u003cp\u003eSurvivor\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e30-day survival\u003c/p\u003e\n\u003cp\u003eExitus\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e30-day survival\u003c/p\u003e\n\u003cp\u003eSurvivor\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePESI score\u003c/p\u003e\n\u003cp\u003eClass I: \u0026lt;65\u003c/p\u003e\n\u003cp\u003eClass II:66\u0026ndash;85\u003c/p\u003e\n\u003cp\u003eClass III:86\u0026ndash;105\u003c/p\u003e\n\u003cp\u003eClass IV:106\u0026ndash;125\u003c/p\u003e\n\u003cp\u003eClass V: \u0026gt;126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e34(13,4)\u003c/p\u003e\n\u003cp\u003e50(19,7)\u003c/p\u003e\n\u003cp\u003e53(20,9)\u003c/p\u003e\n\u003cp\u003e36(14,2)\u003c/p\u003e\n\u003cp\u003e81(31,9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eWhen we looked at the first hospitalisations from the emergency department, the mean value of the HASI was 0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 in patients hospitalised in the ICU and 0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15 in patients hospitalised only in the ward. The HASI value of the patients hospitalised in the ICU was statistically significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eThe mean value of the PESI was 127.39\u0026thinsp;\u0026plusmn;\u0026thinsp;51.83 in patients hospitalised in the ICU and 75.73\u0026thinsp;\u0026plusmn;\u0026thinsp;27.53 in patients hospitalised only in the ward. The PESI score value of the patients hospitalised in the ICU was statistically significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eThe mean ASI was 65.32\u0026thinsp;\u0026plusmn;\u0026thinsp;24.37 in patients hospitalised in the ICU and 42.96\u0026thinsp;\u0026plusmn;\u0026thinsp;13.65 in patients hospitalised only in the ward. The ASI value of the patients hospitalised in the ICU was statistically significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;15 shows the correlation of the HASI, ASI, and PESI with the days of hospitalisation in the ward and the days of hospitalisation in the ICU. As shown in Table\u0026nbsp;15, we observed there was a positive correlation between the high PESI score and the duration of ICU stay, and this correlation created a significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eAccording to the ROC analyses of the patients, the predictive power of all three indices for mortality was found to be statistically significant. In the comparisons made, it was determined that the highest predictive power among the predictive values determined by the area under the curve was in the PESI value (AUC:0.905\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02, 95% CI 0.862\u0026ndash;0.938, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When the cut-off value of the PESI score was 126, the Youden index J value was 0.6874 with a sensitivity of 77.83% and a specificity of 90.91%.\u003c/p\u003e\n\u003cp\u003eAfter the PESI score, the highest AUC value was the HASI (AUC: 0.782\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04, 95% CI 0.726\u0026ndash;0.831, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and if the cut-off value of 0.68 was taken as the power to predict mortality, the Youden index J value of 0.4576 was found to have a sensitivity of 66.97% and a specificity of 78.79%.\u003c/p\u003e\n\u003cp\u003eThe index with the lowest AUC value was the ASI (AUC: 0.748\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04, 95% CI 0.690\u0026ndash;0.800, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and when we took the cut-off value of 73.3 as the power to predict mortality, the Youden index J value was 0.4205 with a sensitivity of 81.45% and a specificity of 60.61%.\u003c/p\u003e\n\u003cp\u003eWhen we compared the indices among themselves, the difference in AUC between the HASI and the SI was 0.033\u0026thinsp;\u0026plusmn;\u0026thinsp;0.013, the 95% confidence interval was 0.00781\u0026ndash;0.0588, and the difference between them was significant in predicting mortality (p\u0026thinsp;=\u0026thinsp;0.0105).\u003c/p\u003e\n\u003cp\u003eWhen we compared the ASI with the PESI, the AUC difference was 0.157\u0026thinsp;\u0026plusmn;\u0026thinsp;0.042, the 95% confidence interval (CI) was 0.0734-0.240, and the difference between them was significant in predicting mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eWhen we compared hypoxia-age-shock and PESI, the difference in AUC was 0.1230\u0026thinsp;\u0026plusmn;\u0026thinsp;0.039, the 95% CI was 0.0467-0.200, and the difference between them was significant in predicting mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). ROC curves of the scores for one-week mortality prediction are given in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eAccording to the ROC analyses of the patients, the predictive power of all three indices for mortality was found to be statistically significant. In the comparisons made, it was determined that the highest predictive power among the predictive values determined by the area under the curve was determined in the PESI value (AUC: 0.915\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02, 95% CI 0.873\u0026ndash;0.946 P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When the cut-off value of PESI score was 122, the Youden index J value was 0.6989 with a sensitivity of 78.05% and a specificity of 91.84%.\u003c/p\u003e\n\u003cp\u003eAfter the PESI score, the highest AUC value was the HASI (AUC:0.764\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04, 95% CI 0.707\u0026ndash;0.815, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the Youden index J value was 0.4166 with a sensitivity of 92.68% and a specificity of 48.98% when the cut-off value of 0.95 was taken for the power to predict mortality.\u003c/p\u003e\n\u003cp\u003eIn this ROC curve, the index with the lowest AUC value was the ASI (AUC: 0.729\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04, 95% CI 0.670\u0026ndash;0.783, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and when we took the cut-off value of 73.3 in the power to predict mortality, the Youden index J value was 0.3852, with a sensitivity of 83.41% and a specificity of 55.10%.\u003c/p\u003e\n\u003cp\u003eWhen we compared the indices among themselves, the difference in AUC between the HASI and the SI was 0.033\u0026thinsp;\u0026plusmn;\u0026thinsp;0.013, the 95% CI was 0.00781\u0026ndash;0.0588, and the difference between them was significant in predicting mortality (p\u0026thinsp;=\u0026thinsp;0.0105).\u003c/p\u003e\n\u003cp\u003eWhen we compared the ASI with the PESI, the AUC difference was 0.157\u0026thinsp;\u0026plusmn;\u0026thinsp;0.042, the 95% CI was 0.0734-0.240, and the difference between them was significant in predicting mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eWhen we compared the HASI and PESI, the difference in AUC was 0.1230\u0026thinsp;\u0026plusmn;\u0026thinsp;0.039, the 95% confidence interval was 0.0467-0.200, and the difference between them was significant in predicting mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eROC curves of the scores for 30-day mortality prediction are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003ePESI scoring includes demographic characteristics such as age and gender, comorbidities such as malignancy, heart failure, chronic lung disease, vital signs such as pulse rate, blood pressure, respiratory rate, oxygen saturation, body temperature, and clinical findings such as altered consciousness. In a study conducted by Tanaka H et al. in 2024, mortality was 5 times higher in patients with a PESI score above 86 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Brown T et al. (2025) determined that the 1-year mortality was \u0026lt;\u0026thinsp;1 in patients with a low PESI score (\u0026le;\u0026thinsp;65) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This scoring is used throughout the world to indicate disease severity and predict mortality in PE[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In a 2005 study, Aujesky et al. found male gender and age to be an independent risk factor in predicting mortality; therefore, male gender and age were included as poor prognostic factors in PESI scoring[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Similarly, Hoskin et al. (2020) observed that male gender increased mortality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. On the same subject, Tanabe et al. found mortality to be higher in the female gender in contrast to other studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In our study, we did not determine any significant difference between male and female patients in terms of mortality.\u003c/p\u003e\u003cp\u003eIn our study, we found that the presence of asthma increased mortalityAsthma is one of the chronic inflammatory diseases associated with procoagulant and antifibrinolytic activities in the airways. The pathophysiology of coagulation in asthmatic patients is activated by increased tissue factor expression in various cell types, decreased activity of the anticoagulant protein C system, and inhibition of fibrinolysis through overproduction of plasminogen activator inhibitor type 1 (PAI1). Therefore, asthma may be a risk factor for PE and can increase mortality, especially in patients with severe disease conditions that include frequent exacerbations.In our study, similar to the literature, [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] the presence of asthma diagnosis significantly increased patients\u0026rsquo; PE mortality.\u003c/p\u003e\u003cp\u003eIn our study, 34 patients were in PESI Class I, and 50 were in PESI Class II. No death was observed in these few patients in both classes. The patient population was not homogenously distributed in PESI classes, and the high-risk patient group was predominant in our study. In the PESI Class III group, the 1-week mortality rate was 1.88%, and the 30-day mortality rate was 5.66%, which is close to the expected mortality rate in the PESI derivation and validation study. In PESI Class IV, the 1-week mortality rate was 5.55%, and the 30-day mortality rate was 11.11%. In PESI Class V, which had the highest number of patients and the highest mortality rate in our study, the 1-week mortality rate was 37.03%, and the 30-day mortality rate was 51.85%. In the study published by Drahomir Aujesky et al. in 2005, the expected mortality rates in Class IV and V were 4-11.4% and 10-24.5%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In our study, we observed a higher mortality rate than the mortality rates in the literature, especially in Classes IV and V. This may be due to the high number of patients with advanced age and malignancy and the fact that the life expectancy of patients with malignancy is not long. In our study, we determined that the sensitivity and specificity were 77.83% and 90.91%, respectively, when the cut-off value of PESI score was 126). Yu Zhou et al. (2012) found that the sensitivity of the PESI score in predicting mortality was 90% and that the specificity was 41% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In comparing sPESI with PESI, Wei-Ying Jen et al. determined the PESI sensitivity to be 81.8% and the specificity to be 36.1%; however, for the RIETE score, E. Jaquet et al. found the sensitivity of PESI to be 96% and the specificity to be 36% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] investigated the usability of the ASI and HASI first introduced to the literature in 2022 by Chien-Chieh Hsieh et al., assessing 262 patients diagnosed with COVID-19 on patients with PE. In the study conducted in 2022, the effect of the ASI on mortality was AUC: 0.773 (CI 95% 0.725\u0026ndash;0.821), and its sensitivity was 93.33%, with a specificity of 56.85% when the cut-off point was 44.35 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our study, AUC: 0.729 (95% CI 0.670\u0026ndash;0.783) was found to have a sensitivity of 83.41% and specificity of 55.10% when we took a cut-off value of 73.3 in the power to predict mortality. When we looked at the effect of the HASI on mortality in the same study, AUC: 0.774 (95% CI 0.716\u0026ndash;0.823), when we took a cut-off value of 0.48, its sensitivity was 93.33%, and its specificity was 58.92%. In our study, the AUC of the HASI was 0.764 (95% CI 0.707\u0026ndash;0.815), its sensitivity was 92.68%, and its specificity was 48.98% when the cut-off value was 0.95. This shows that the ASI and HASI can be used significantly to predict PE mortality.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOne limitation of our research was that it was single-centre study, and the ASI and HASI were measured only at the time of admission. In future studies, more than one centre can be included, the number of patients can be increased, and repeated measurements of the ASI and HASI can be recorded.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn patients with pulmonary embolism, the order of predictive power for 1-week and 30-day mortality was PESI, HASI, and ASI. Although HASI and ASI can be calculated more rapidly than PESI, their predictive power for mortality in our study was found to be close to that of PESI. Therefore, validation through multicentre prospective studies would provide important contributions to the literature.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAll authors declare that they have no conflict of interest.\u003c/p\u003e\u003cp\u003eFunding: None to declare\u003c/p\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHassine M, Kallala MY, Mahjoub M, Boussaada M, Bouchahda N, Gamra H (2023) Pulmonary embolism: the Pulmonary Embolism Severity Index (PESI) score and mortality predictors. Pan Afr Med J 45:48\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026ouml;k\u0026ccedil;ek K, G\u0026ouml;k\u0026ccedil;ek A, Demir A, Yıldırım B, Acar E, Alataş \u0026Ouml;D (2022) In-hospital mortality of acute pulmonary embolism: Predictive value of shock index, modified shock index, and age shock index scores. Med Clin (Barc) 158(8):351\u0026ndash;355\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShen Y, Wan C, Yang M et al (2021) The hypoxia-age-shock index as a predictive tool in emergency medicine. Emerg Med J 38(10):733\u0026ndash;738\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOh S, Lee K (2023) The new combination of oxygen saturation with age shock index predicts the outcome of COVID-19 pneumonia. SAGE Open Med. ;11\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen PS, Hsieh CY, Jaw FS, Chen HK, Hsi KY, Chang HP (2024) The hypoxia-age-shock index at triage is a useful and rapid tool. 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Am J Cardiol 122(6):1079\u0026ndash;1084\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee PH, Fu PK (2019) Pulmonary embolism and severe asthma: Case report and literature review. Medicina 55(10):647\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMajoor CJ, Kamphuisen PW, Zwinderman AH, ten Brinke A, Amelink M, Rijssenbeek-Nouwens L, Sterk PJ, B\u0026uuml;ller HR, Bel EH (2013) Deep vein thrombosis and risk of pulmonary embolism in asthma. Eur Respir J 42:655\u0026ndash;661\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung W-S, Lin C-L, Ho F-M, Li R-Y, Sung F-C, Kao C-H, Yeh J-J (2014) Asthma increases the risk of pulmonary thromboembolism: A nationwide population cohort study. Eur Respir J 43:801\u0026ndash;807\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou XY, Ben SQ, Chen HL, Ni SS (2012) The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis. Respir Res 13(1):111\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaquet E, Tritschler T, Stalder O, Limacher A, M\u0026eacute;an M, Rodondi N et al (2018) Prediction of short term prognosis in elderly patients with acute pulmonary embolism: validation of the RIETE score. J Thromb Haemostasis July 16(7):1313\u0026ndash;1320\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJen WY, Jeon YS, Kojodjojo P, Lee EHE, Lee YH, Ren YP, Tan TJS, Song Y, Zhang T, Teo L, Feng M, Chee YL (2018) A New Model for Risk Stratification of Patients With Acute Pulmonary Embolism. Clin Appl Thromb Haemost 24(9):277S\u0026ndash;284S\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHsieh CC, Liu CY, Tsai KC, Jaw FS, Chen J (2023) The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients. Am J Emerg Med 65:65\u0026ndash;70\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary Embolism, emergency department, prognosis, mortality, Hypoxia-age-shock index, Age-shock index, Pulmonary Embolism Severity Index","lastPublishedDoi":"10.21203/rs.3.rs-7566851/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7566851/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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 \u0026lt; 0.001) was higher compared to HASI (AUC: 0.782 ± 0.04; 95% CI: 0.726–0.831; p \u0026lt; 0.001) and ASI (AUC: 0.748 ± 0.04; 95% CI: 0.690–0.800; p \u0026lt; 0.001). For 30-day mortality, ROC analysis likewise showed that PESI (AUC: 0.915 ± 0.02; 95% CI: 0.873–0.946; p \u0026lt; 0.001) had higher predictive power than HASI (AUC: 0.764 ± 0.04; 95% CI: 0.707–0.815; p \u0026lt; 0.001) and ASI (AUC: 0.729 ± 0.04; 95% CI: 0.670–0.783; p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn predicting both 1-week and 30-day mortality in PE patients, the best predictive power was determined PESI, HASI, and ASI consecutevely.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 12:29:00","doi":"10.21203/rs.3.rs-7566851/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61eb760a-3a9b-4d8e-bcc8-bc05b8d6b07a","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-04T13:34:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 12:29:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7566851","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7566851","identity":"rs-7566851","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}