Miletic Kyle G, Spiering Tyler J, Delius Ralph E, Walters Henry L, Mastropietro Christopher W
Wayne State University School of Medicine, Detroit, MI, USA.
Department of Surgery, Division of Cardiothoracic Surgery, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA.
Interact Cardiovasc Thorac Surg. 2015 Mar;20(3):289-95. doi: 10.1093/icvts/ivu409. Epub 2014 Dec 8.
Prior studies have established peak postoperative lactate and the vasoactive-inotrope score (VIS) as modest predictors of outcome following paediatric cardiac surgery. We developed a novel vasoactive-ventilation-renal (VVR) score and aimed to determine if this index, which incorporates postoperative respiratory, cardiovascular and renal function, would more consistently predict outcome in this patient population.
We performed an Institutional Review Board-approved retrospective analysis of 222 infants at our institution less than 365 days old who underwent surgery for congenital heart disease at our centre from January 2009 to April 2013. The VVR score was calculated as follows: vasoactive-inotrope score + ventilation index + (change in serum creatinine from baseline × 10). For all patients, peak lactate and admission, peak, and 48 h VIS and VVR were recorded.
For all outcome measures, areas under the curve for 48-h VVR were greater than its corresponding admission and peak values, VIS alone at all three time points and peak lactate. On multivariate regression, 48-h VVR was strongly associated with prolonged intubation [odds ratio (OR): 39.13, P <0.0001], significantly more so than 48-h VIS (odds ratio: 6.18, P <0.0001) and peak lactate (odds ratio: 2.52, P = 0.017). The 48-h VVR was also more significantly associated with prolonged use of vasoactive infusions, chest tube drainage and ICU and hospital stay when compared with VIS alone and peak lactate.
The novel 48-h VVR was a robust predictor of outcome following paediatric cardiac surgery and outperformed the VIS and peak postoperative lactate.
先前的研究已确定术后乳酸峰值和血管活性药物-正性肌力药物评分（VIS）可作为小儿心脏手术后预后的适度预测指标。我们开发了一种新的血管活性-通气-肾脏（VVR）评分，并旨在确定这个综合了术后呼吸、心血管和肾功能的指标是否能更一致地预测该患者群体的预后。
我们对2009年1月至2013年4月在本中心接受先天性心脏病手术的222名年龄小于365天的婴儿进行了一项经机构审查委员会批准的回顾性分析。VVR评分的计算方法如下：血管活性药物-正性肌力药物评分+通气指数+（血清肌酐相对于基线的变化×10）。记录所有患者的乳酸峰值以及入院时、峰值时和48小时的VIS和VVR。
对于所有预后指标，48小时VVR的曲线下面积均大于其相应的入院时和峰值时的值、所有三个时间点单独的VIS以及乳酸峰值。在多变量回归分析中，48小时VVR与插管时间延长密切相关[比值比（OR）：39.13，P<0.0001]，比48小时VIS（比值比：6.18，P<0.0001）和乳酸峰值（比值比：2.52，P=0.017）更显著。与单独的VIS和乳酸峰值相比，48小时VVR还与血管活性药物输注的延长使用、胸管引流以及ICU和住院时间更显著相关。
新的48小时VVR是小儿心脏手术后预后的有力预测指标，其表现优于VIS和术后乳酸峰值。
