Is the Shock Index a Useful Prognostic Indicator in Acute Upper Gastrointestinal Bleeding in the Emergency Department? Publisher



Oraei A ; Kalantari A ; Karimizadeh Z ; Vahidi E
Source: Journal of Emergency Medicine, Trauma and Acute Care Published:2026

Abstract

Objective: Acute upper gastrointestinal bleeding (AUGIB) is a common and potentially life-threatening condition requiring rapid risk stratification in emergency departments (EDs). Shock Index (SI), calculated as pulse rate (PR) divided by systolic blood pressure (SBP), is an accessible bedside tool. The objective was to evaluate the prognostic value of admission SI in predicting in-hospital mortality among AUGIB cases in the ED. Methods: This retrospective cross-sectional study included adult patients with AUGIB admitted to the ED of a tertiary referral hospital from March 2021 to March 2023. Demographic, vital signs, and clinical data were extracted from medical records. SI was calculated upon admission. The in-hospital mortality rate was recorded. Appropriate analysis was performed to identify independent predictors of in-hospital mortality. Results: A total of 188 patients (mean age, 59.35 ± 18.01 years old; 68.09% males) were included. The overall in-hospital mortality rate was 11.17%. Multivariable analysis identified SI (odds ratio [OR] = 5.78 [95% CI, 1.08–30.87]; P = 0.040), age (OR = 1.06; P = 0.001), and transfused packed red blood cell units (OR = 1.22; P = 0.002) as independent predictors of mortality. SI also showed a moderate negative correlation with baseline hemoglobin and a weak positive correlation with transfusion requirements. Conclusion: Admission SI was an independent predictor of in-hospital mortality in patients with AUGIB and may serve as a rapid, practical tool for early risk assessment in the ED. © 2026 Oraei, Kalantari, Karimizadeh, Vahidi, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0 https://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0/