Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Anesth. 2018 Apr;32(2):167-173. doi: 10.1007/s00540-018-2447-2. Epub 2018 Jan 13.
The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery.
A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed "poor outcome", which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation.
After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51-18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10-2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28-2.74, p = 0.001).
The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults.
血管活性-正性肌力评分（VIS）是一种显示血管活性和正性肌力支持程度的量表。最近，有人提出心脏手术后的 VIS 可预测婴儿的发病率和死亡率。本研究旨在评估手术结束时的 VIS 是否可预测成人心脏手术的发病率和死亡率。
对一所大学医院的 129 例成人心脏手术患者进行回顾性队列研究。主要结局为“不良结局”，由发病率和死亡率组成。次要结局为 ICU 住院时间和首次拔管时间。采用多变量逻辑回归分析评估 VIS 与不良结局之间的关联。采用比例风险模型评估 ICU 住院时间和首次拔管时间。
在调整 EuroSCORE、术前射血分数和体外循环时间后，手术结束时高 VIS 与不良结局相关，调整后的优势比为 4.87（95%置信区间 1.51-18.94；p=0.007）。在控制 EuroSCORE 和体外循环时间后，高 VIS 患者 ICU 住院时间更长（风险比 1.62；95%置信区间 1.10-2.39；p=0.015），通气时间也更长（风险比 1.87；95%置信区间 1.28-2.74，p=0.001）。
心脏手术后心血管支持的程度可能预测成人的发病率和死亡率。
