Department of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland; Department of Anaesthesia and Intensive Care, North Karelia Central Hospital, Joensuu, Finland.
Department of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland.
Br J Anaesth. 2019 Apr;122(4):428-436. doi: 10.1016/j.bja.2018.12.019. Epub 2019 Feb 18.
The vasoactive-inotropic score (VIS) predicts mortality and morbidity after paediatric cardiac surgery. Here we examined whether VIS also predicted outcome in adults after cardiac surgery, and compared predictive capability between VIS and three widely used scoring systems.
This single-centre retrospective cohort study included 3213 cardiac surgery patients. Maximal VIS (VIS) was calculated using the highest doses of vasoactive and inotropic medications administered during the first 24 h post-surgery. We established five VIS categories: 0-5, >5-15, >15-30, >30-45, and >45 points. The predictive accuracy of VIS was evaluated for a composite outcome, which included 30-day mortality, mediastinitis, stroke, acute kidney injury, and myocardial infarction.
VIS showed good prediction accuracy for the composite outcome [area under the curve (AUC), 0.72; 95% confidence interval (CI), 0.69-0.75]. The incidence of the composite outcome was 9.6% overall and 43% in the highest VIS group (>45). VIS predicted 30-day mortality (AUC, 0.76; 95% CI, 0.69-0.83) and 1-yr mortality (AUC, 0.70; 95% CI, 0.65-0.74). Prediction accuracy for unfavourable outcome was significantly better with VIS than with Acute Physiology and Chronic Health Evaluation II (P=0.01) and Simplified Acute Physiological Score II (P=0.048), but not with the Sequential Organ Failure Assessment score (P=0.32).
In adults after cardiac surgery, VIS predicted a composite of unfavourable outcomes and predicted mortality up to 1 yr after surgery.
血管活性-正性肌力评分（VIS）可预测儿科心脏手术后的死亡率和发病率。在此，我们研究了 VIS 是否也能预测成人心脏手术后的结果，并比较了 VIS 与三种广泛使用的评分系统的预测能力。
这是一项单中心回顾性队列研究，纳入了 3213 例心脏手术患者。最大 VIS（VIS）是通过计算术后 24 小时内给予的最高剂量的血管活性和正性肌力药物来计算的。我们建立了五个 VIS 类别：0-5、>5-15、>15-30、>30-45 和>45 分。评估了 VIS 对包括 30 天死亡率、纵隔炎、卒中和急性肾损伤在内的复合结局的预测准确性。
VIS 对复合结局有较好的预测准确性（曲线下面积（AUC）为 0.72；95%置信区间（CI）为 0.69-0.75）。总体复合结局的发生率为 9.6%，最高 VIS 组（>45）为 43%。VIS 预测 30 天死亡率（AUC 为 0.76；95%CI 为 0.69-0.83）和 1 年死亡率（AUC 为 0.70；95%CI 为 0.65-0.74）。与急性生理和慢性健康评估 II 评分（P=0.01）和简化急性生理学评分 II 评分（P=0.048）相比，VIS 对不良结局的预测准确性明显更好，但与序贯器官衰竭评估评分（P=0.32）相比则无明显差异。
在成人心脏手术后，VIS 预测了复合不良结局，并预测了术后 1 年的死亡率。
