{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T22:40:50Z","timestamp":1769208050728,"version":"3.49.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n The Shock Index (SI) is a validated prognostic tool in conditions such as severe trauma and obstetric hemorrhage. During the COVID-19 pandemic, it was used to identify patients at higher risk of clinical deterioration, but results have been inconsistent. This study aimed to evaluate the prognostic value of the SI and its variants in predicting mortality, need for mechanical ventilation, and hospital length of stay in patients with moderate COVID-19.<\/jats:p>\n <\/jats:sec>\n \n Methods and findings<\/jats:title>\n This longitudinal analytical observational study was conducted at a high-complexity hospital in southwestern Colombia and included adults over 18 years of age with moderate COVID-19 treated between 2020 and 2022, using data from the institutional RECOVID registry. A total of 283 patients were analyzed (median age: 61 years; 58.7% male), with cardiovascular and renal comorbidities being predominant. On admission, vital signs were stable (NEWS2: 3.0; shock index: 0.7). ICU admission was required in 29.3% of cases, and overall mortality was 12%. ROC curves and diagnostic accuracy parameters were used to assess the discriminatory ability of the SI and its variants. Most SI variants showed low discriminatory power (AUC\u2009<\u20090.58), except for the estimated shock index and the heart rate\u2013adjusted shock index for mortality, with AUCs of 0.70 and 0.68, respectively, and positive predictive values exceeding 93%.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Early identification of patients at risk for complications in moderate COVID-19 is essential for optimizing hospital resources. The shock index and its variants showed limited utility as standalone predictors for mortality, ICU admission, and hospital length of stay. Combining SI with other clinical parameters may offer some benefit, but heterogeneity limits generalizability. Future studies should develop and prospectively validate multivariable models integrating clinical, laboratory, and imaging biomarkers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0341634","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T18:44:09Z","timestamp":1769193849000},"page":"e0341634","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking emergency risk assessment: A single-center look at shock index and its variants in COVID-19"],"prefix":"10.1371","volume":"21","author":[{"given":"Annyi Tatiana","family":"Belalcazar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria Monroy","family":"Lasso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Dar\u00edo","family":"\u00c1lvarez Herazo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0925-2370","authenticated-orcid":true,"given":"Ana","family":"Clarete","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9265-5420","authenticated-orcid":true,"given":"Roger","family":"Figueroa-Paz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duban","family":"Maya-Portillo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio","family":"Diez-Sep\u00falveda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"issue":"10371","key":"pone.0341634.ref001","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0140-6736(23)00050-8","article-title":"The COVID-19 pandemic in 2023: far from over","volume":"401","author":"Lancet The","year":"2023","journal-title":"Lancet"},{"key":"pone.0341634.ref002","volume-title":"Dasbor WHO Coronavirus Disease (COVID-19","author":"WHO","year":"2021"},{"key":"pone.0341634.ref003","article-title":"Lineamientos nacionales para la vigilancia en salud p\u00fablica 2025 (vigilancia basada en eventos predefinidos)","author":"FE Prieto Alvarado","year":"2024","journal-title":"Instituto Nacional de Salud - Direcci\u00f3n de Vigilancia y An\u00e1lisis del Riesgo en Salud P\u00fablica"},{"issue":"4","key":"pone.0341634.ref004","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1093\/cid\/ciad618","article-title":"A Systematic Review of Predictor Composition, Outcomes, Risk of Bias, and Validation of COVID-19 Prognostic Scores","volume":"78","author":"KS Appel","year":"2024","journal-title":"Clin Infect Dis"},{"key":"pone.0341634.ref005","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ijid.2021.07.049","article-title":"ABC2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores","volume":"110","author":"MS Marcolino","year":"2021","journal-title":"Int J Infect Dis"},{"key":"pone.0341634.ref006","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ajem.2022.12.034","article-title":"The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients","volume":"65","author":"C-C Hsieh","year":"2023","journal-title":"Am J Emerg Med"},{"key":"pone.0341634.ref007","article-title":"Prognostic Performance of Shock Index, Diastolic Shock Index, Age Shock Index, and Modified Shock Index in COVID-19 Pneumonia","volume":"17","author":"M Avci","year":"2022","journal-title":"Disaster Med Public Health Prep"},{"issue":"8","key":"pone.0341634.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e18553","article-title":"Shock index in the emergency department as a predictor for mortality in COVID-19 patients: A systematic review and meta-analysis","volume":"9","author":"MY Alsagaff","year":"2023","journal-title":"Heliyon"},{"issue":"1","key":"pone.0341634.ref009","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2022-001340","article-title":"Comparison of prognostic scores for inpatients with COVID-19: a retrospective monocentric cohort study","volume":"9","author":"J Martin","year":"2022","journal-title":"BMJ Open Resp Res"},{"issue":"4","key":"pone.0341634.ref010","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1017\/dmp.2021.187","article-title":"The Usefulness of Shock Index and Modified Shock Index in Predicting the Outcome of COVID-19 Patients","volume":"16","author":"E Kurt","year":"2022","journal-title":"Disaster Med Public Health Prep"},{"issue":"5","key":"pone.0341634.ref011","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1002\/ehf2.14853","article-title":"Decoding cardiogenic shock: assessing shock index and its variants as prognostic indicators for in-hospital mortality","volume":"11","author":"L Colarusso","year":"2024","journal-title":"ESC Heart Fail"},{"issue":"2","key":"pone.0341634.ref012","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jemermed.2023.11.010","article-title":"Relationship between shock index, modified shock index, and age shock index and 28-day mortality among patients with prehospital septic shock","volume":"66","author":"R Jouffroy","year":"2024","journal-title":"J Emerg Med"},{"issue":"1","key":"pone.0341634.ref013","doi-asserted-by":"crossref","first-page":"2311854","DOI":"10.1080\/07853890.2024.2311854","article-title":"Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients","volume":"56","author":"S Wang","year":"2024","journal-title":"Ann Med"},{"issue":"1","key":"pone.0341634.ref014","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/jets.jets_118_22","article-title":"A Comparative Study on Predictive Validity of Modified Shock Index, Shock Index, and Age Shock Index in Predicting the Need for Mechanical Ventilation among Sepsis Patients in a Tertiary Care Hospital","volume":"16","author":"KJD Prasad","year":"2023","journal-title":"J Emerg Trauma Shock"},{"issue":"1","key":"pone.0341634.ref015","doi-asserted-by":"crossref","first-page":"19696","DOI":"10.1038\/s41598-022-24272-9","article-title":"Predictive value of shock index variants on 30-day mortality of trauma patients in helicopter emergency medical services: a nationwide observational retrospective multicenter study","volume":"12","author":"T Iirola","year":"2022","journal-title":"Sci Rep"},{"key":"pone.0341634.ref016","unstructured":"COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. https:\/\/covid19treatmentguidelines.nih.gov\/. 2020."},{"issue":"5","key":"pone.0341634.ref017","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1002\/jhm.13106","article-title":"Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19","volume":"18","author":"PA Prasad","year":"2023","journal-title":"J Hosp Med"},{"key":"pone.0341634.ref018","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ajem.2021.05.049","article-title":"Early detection of hospitalized patients with COVID-19 at high risk of clinical deterioration: Utility of emergency department shock index","volume":"49","author":"IHT van Rensen","year":"2021","journal-title":"Am J Emerg Med"},{"key":"pone.0341634.ref019","article-title":"Shock Index VS Modified Shock Index as a Predictor of Mortality among the COVID-19 Patients","author":"A S","year":"2024","journal-title":"MDPI AG"},{"issue":"1","key":"pone.0341634.ref020","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4274\/imj.galenos.2023.44380","article-title":"Investigation of the Prognostic Values of the Shock Index and Modified Shock Index in Predicting the Clinical Outcomes in Elderly Hospitalized Patients with Coronavirus Disease-2019","volume":"24","author":"S Ye\u015filta\u015f","year":"2023","journal-title":"Istanbul Med J"},{"key":"pone.0341634.ref021","doi-asserted-by":"crossref","first-page":"7619","DOI":"10.2147\/IDR.S395095","article-title":"Comparison Between Physiological Scores SIPF, CURB-65, and APACHE II as Predictors of Prognosis and Mortality in Hospitalized Patients with COVID-19 Pneumonia: A Multicenter Study, Saudi Arabia","volume":"15","author":"S Eldaboosy","year":"2022","journal-title":"Infect Drug Resist"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341634","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T18:44:13Z","timestamp":1769193853000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341634"}},"subtitle":[],"editor":[{"given":"Armaan","family":"Jamal","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0341634","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]}}}