Poterucha Joseph T, Vallabhajosyula Saraschandra, Egbe Alexander C, Krien Joseph S, Aganga Devon O, Holst Kimberly, Golden Adele W, Dearani Joseph A, Crow Sheri S
Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
Congenit Heart Dis. 2019 Mar;14(2):193-200. doi: 10.1111/chd.12717. Epub 2018 Nov 19.
High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD).
We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity.
Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4%) met study inclusion criteria. Sixty-two patients (25%), experienced composite poor outcome [including eight deaths within 90 days of hospital discharge (3%)]. Thirty-eight patients (15%) endured complication related early morbidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95% CI: 0.86-0.98) for in-hospital mortality; and 0.82 (95% CI: 0.76-0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of composite adverse outcome (OR: 14.2, 95% CI: 7.2-28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95% CI: 8.7-42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95% CI: 4.4-41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95% CI: 3.4-15.5; P < 0.0001).
MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.
先天性心脏病手术后高水平的血管活性正性肌力药物支持（VIS）可预测儿科患者的发病情况。我们试图确定这种关系是否适用于患有先天性心脏病的成人（ACHD）。
我们回顾性研究了2002年至2013年在梅奥诊所接受先天性心脏病心脏手术后入住重症监护病房的成年患者（≥18岁）。检查入院96小时内的血管活性药物剂量值，以确定VIS评分与早期死亡、早期发病或并发症相关发病的不良结局之间的关系。
总体而言，1040例ACHD患者在研究时间段内接受了心脏手术；243例（23.4%）符合研究纳入标准。62例患者（25%）出现综合不良结局[包括8例在出院后90天内死亡（3%）]。38例患者（15%）经历了并发症相关的早期发病。住院死亡率的曲线下最大VIS（maxVIS）评分为0.92（95%CI：0.86 - 0.98）；综合不良临床结局的评分为0.82（95%CI：0.76 - 0.89）。单因素分析显示，maxVIS评分≥3可预测综合不良结局（OR：14.2，95%CI：7.2 - 28.2；P < 0.001）、延长的重症监护病房住院时间（ICU LOS）（OR：19.2；95%CI：8.7 - 42.1；P < 0.0001）、延长的机械通气时间（OR：13.6；95%CI：4.4 - 41.8；P < 0.0001）以及并发症相关发病（OR：7.3；95%CI：3.4 - 15.5；P < 0.0001）。
MaxVIS评分强烈预测不良结局，可作为一种风险预测工具，以促进早期干预，这可能改善结局并协助ACHD患者心脏手术后的临床决策。
