Background Acute pulmonary embolism (APE) is a common and potentially fatal disease. The main challenges in managing this disease lie first in rapid diagnosis and accurate assessment of prognostic stratification.

Objective To analyze the predictive value of system inflammation response index (SIRI), aggregate index of systemic inflammation (AISI) and systemic immune-inflammation index (SII) in the diagnosis and risk stratification of acute pulmonary embolism (APE).

Methods Patients diagnosed with acute pulmonary embolism and admitted to the Department of Respiratory and Critical Care Medicine at Shengjing Hospital Affiliated to China Medical University from June 2020 to March 2023 (APE group) were retrospectively collected, while patients admitted during the same period with severe dyspnea but without acute pulmonary embolism served as the control group. The differences of SIRI, AISI and SII between the two groups and their predictive values for APE in diagnosis and risk stratification were compared.

Results A total of 127 patients were enrolled in the APE group, including 58 males and 69 females, with an average age of (64.50 ± 13.46) years. The control group consisted of 124 patients without acute pulmonary embolism (63 males, 61 females, mean age: 62.49 ± 10.74 years). There were no significant differences in these demographic indicators between the two groups. Based on the stratification criteria for acute pulmonary embolism, they were divided into low-risk group (43 cases), medium-low risk group (31 cases), medium-high risk group (28 cases), and high-risk group (25 cases). The levels of SII, SIRI, and AISI were significantly higher in the pulmonary embolism group compared to the control group (all P<0.05). Multivariate logistic regression analysis revealed that elevated levels of SIRI (OR: 1.458; 95% CI: 1.119-1.900), AISI (OR: 1.796; 95% CI: 1.298-2.488) and SII (OR: 1.303; 95% CI: 1.093-1.555) were all independent risk factors for developing acute pulmonary embolism among patients. Receiver operating characteristic curve analysis demonstrated that combining SIRI, AISI, and SII had the highest predictive value for acute pulmonary embolism with an area under the curve (AUC) of 0.804. In terms of risk stratification for acute pulmonary embolism, non-low-risk groups exhibited higher values of SII, SIRI, and AISI compared to low-risk groups. The higher the values of SII, SIRI, and AISI, the greater their association with increased risk stratification for acute pulmonary embolism. Specifically, SII showed superior predictive value within the subgroup affected by pulmonary embolism with an AUC of 0.865 and a sensitivity of 82.1%. The specificity was 88.4%.

Conclusion SIRI, AISI and SII are useful in predicting acute pulmonary embolism and risk stratification.