Bellapukonda Snigdha, Rayani Basanth K, Naik Vibhavari
Department of Onco-Anaesthesia, Pain and Palliative Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, 500034 India.
Present Address: Department of Anesthesiology, Kamineni Academy of Medical Sciences and Research Centre, L. B. Nagar, Telangana, 500068 India.
Indian J Surg Oncol. 2024 Dec;15(4):844-848. doi: 10.1007/s13193-024-02004-x. Epub 2024 Jun 29.
In this study, we evaluated Vasoactive Inotrope score (VIS) for prognosis in onco-surgery patients and determine whether there is correlation between VIS and grade of complication (according to Modified Clavien-Dindo Classification). This prospective observational study was conducted at Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India. The setting conducted at a tertiary care referral centre. The participants aged 18-65 years, undergoing major abdominopelvic and thoracic onco-surgeries, requiring vasopressor and ionotropic support in an intensive care unit from May 2022 to February 2023, were recruited into the study. Thus, 257 patients were enrolled. Patients were given noradrenaline, adrenaline, vasopressin, dopamine, and dobutamine. Patients, on other vasopressor infusions, who lost to follow-up and are not willing to participate in the study were excluded. The following are the main outcome(s) and measure(s): Initial Vasoactive Inotrope score (VIS), maximum Vasoactive Inotrope score (VIS), and grade of complication. VIS has significant positive correlation ( = 0.147; = 0.01) with grade of complication. Both VIS and VIS have a significant positive correlation with length of ICU stay ( = 0.164, = 0.001; = 0.242, = 0.001). Also there is a significant Odds Ratio (OR = 1.068; 95% CI = 1.004-1.136; = 0.036) of patient having ≥ Grade 3 complication if VIS increases by a unit. A cutoff of VIS > 5.1 had a sensitivity of 82.1% and specificity of 33.5% ( = 0.014) to predict ≥ Grade 3 complications. VIS may be helpful in predicting higher grade of complication and length of ICU stay in onco-surgery patients. This study is the very first one to evaluate VIS in cancer patients; further studies would help in strengthening the findings. Trial Registration: CTRI/2022/09/045237; www.ctri.nic.in.
在本研究中,我们评估了血管活性正性肌力药物评分(VIS)对肿瘤外科手术患者预后的影响,并确定VIS与并发症分级(根据改良Clavien-Dindo分类法)之间是否存在相关性。这项前瞻性观察性研究在印度海得拉巴的巴萨瓦塔拉卡姆印美癌症医院和研究所进行。研究在一家三级医疗转诊中心开展。研究招募了年龄在18至65岁之间、接受大型腹部盆腔和胸部肿瘤手术、于2022年5月至2023年2月期间在重症监护病房需要血管升压药和正性肌力支持的患者。因此,共纳入了257例患者。患者接受去甲肾上腺素、肾上腺素、血管加压素、多巴胺和多巴酚丁胺治疗。排除接受其他血管升压药输注、失访且不愿参与研究的患者。以下是主要结局和指标:初始血管活性正性肌力药物评分(VIS)、最高血管活性正性肌力药物评分(VIS)和并发症分级。VIS与并发症分级具有显著正相关(=0.147;=0.01)。VIS和VIS均与重症监护病房住院时间具有显著正相关(=0.164,=0.001;=0.242,=0.001)。此外,如果VIS增加一个单位,患者发生≥3级并发症的显著优势比为(OR = 1.068;95% CI = 1.004 - 1.136;= 0.036)。VIS>5.1的临界值预测≥3级并发症的敏感性为82.1%,特异性为33.5%(=0.014)。VIS可能有助于预测肿瘤外科手术患者更高等级的并发症和重症监护病房住院时间。本研究是首个评估癌症患者VIS的研究;进一步的研究将有助于强化这些发现。试验注册号:CTRI/2022/09/045237;www.ctri.nic.in。