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Background: The COVID-19 outbreak presents challenges to the emergency care system. Advanced age is a risk factor for mortality. This study aimed to investigate whether the shock index (SI) is an early predictor of adverse outcomes in geriatric patients with COVID-19.

Methods: Patients aged ≥ 60 years with COVID-19 between May 1, 2021, and February 1, 2022,were included in a retrospective cohort study. These patients were divided into two groups based on ICU admission. Variables were compared for the two groups. The receiver operating characteristic analysis of the SI and age–SI (ASI) was used to detect deteriorating outcomes early.

Results: In total, 156 patients were included, and the mean age was 68.52 ± 7.25 years. ICU admission, intubation, and mortality were recorded in 46 (29.49%), 32 (20.51%), and 16 (10.26%) patients, respectively. The mean body weight, pulse rate, respiratory rate, pulse oximetry, SI, and ASI were significantly different between the two groups (p = 0.018, 0.032, 0.007, < 0.001, 0.004, and 0.007, respectively). CRP, LDH, ALT, ferritin, D-dimer, and sodium levels were significantly associated with ICU admission. Regarding ICU admission, intubation, and mortality, the areas under the curve (AUC) of the SI and ASI showed acceptable discrimination. The predictive power of the ASI was significantly higher than that of the SI for mortality (AUC difference, 0.088 ± 0.036 (95% CI 0.017-0.160); p = 0.016).

Conclusion: The ASI is a useful triage tool for mortality prediction in geriatric patients with COVID-19. The SI and ASI can be used in conjunction with vital signs, oxygen saturation, and laboratory biomarkers for the early detection of ICU admission.