Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Transpl Int. 2024 Jul 25;37:11354. doi: 10.3389/ti.2024.11354. eCollection 2024.
In the early postoperative stage after heart transplantation, there is a lack of predictive tools to guide postoperative management. Whether the vasoactive-inotropic score (VIS) can aid this prediction is not well illustrated.
In total, 325 adult patients who underwent heart transplantation at our center between January 2015 and December 2018 were included. The maximum VIS (VIS) within 24 h postoperatively was calculated. The Kaplan-Meier method was used for survival analysis. A logistic regression model was established to determine independent risk factors and to develop a nomogram for a composite severe adverse outcome combining early mortality and morbidity.
VIS was significantly associated with extensive early outcomes such as early death, renal injury, cardiac reoperation and mechanical circulatory support in a grade-dependent manner, and also predicted 90-day and 1-year survival ( < 0.05). A VIS-based nomogram for the severe adverse outcome was developed that included VIS, preoperative advanced heart failure treatment, hemoglobin and serum creatinine. The nomogram was well calibrated (Hosmer-Lemeshow = 0.424) with moderate to strong discrimination (C-index = 0.745) and good clinical utility.
VIS is a valuable prognostic index in heart transplantation. In the early post-transplant stage, this VIS-based nomogram can easily aid intensive care clinicians in inferring recipient status and guiding postoperative management.
心脏移植术后早期，缺乏预测工具来指导术后管理。血管活性-正性肌力评分（VIS）是否有助于预测这一点尚未得到充分说明。
共纳入 2015 年 1 月至 2018 年 12 月期间在我院接受心脏移植的 325 例成年患者。计算术后 24 小时内最大 VIS（VIS）。采用 Kaplan-Meier 法进行生存分析。建立逻辑回归模型确定独立危险因素，并开发一个包含早期死亡率和发病率的复合严重不良结局的列线图。
VIS 与广泛的早期结局显著相关，如早期死亡、肾损伤、心脏再次手术和机械循环支持，且呈分级依赖性，还预测 90 天和 1 年的生存率（<0.05）。建立了基于 VIS 的严重不良结局列线图，包括 VIS、术前晚期心力衰竭治疗、血红蛋白和血清肌酐。该列线图校准良好（Hosmer-Lemeshow = 0.424），具有中度至较强的区分度（C 指数= 0.745）和良好的临床实用性。
VIS 是心脏移植的有价值的预后指标。在移植后早期阶段，这个基于 VIS 的列线图可以帮助重症监护临床医生轻松推断受者的状态并指导术后管理。
