Predictive Value of Vasoactive-inotropic Score for Mortality in Newborns Undergoing Cardiac Surgery

• Published in: Indian pediatrics Vol. 56; no. 9; pp. 735 - 740
• Main Authors: Dilli, Dilek, Akduman, Hasan, Orun, Utku Arman, Tasar, Mehmet, Tasoglu, Irfan, Aydogan, Seda, Citli, Rumeysa, Tak, Sercan
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-09-2019
• Subjects: Cardiac Surgical Procedures - mortality; Clinical Decision Rules; Female; Follow-Up Studies; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Humans; Infant, Newborn; Length of Stay - statistics & numerical data; Male; Maternal and Child Health; Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics; Predictive Value of Tests; Prospective Studies; Research Paper; Respiration, Artificial - statistics & numerical data; Sensitivity and Specificity; Severity of Illness Index; Survival Analysis; Treatment Outcome; Congenital heart disease; Repair; Survival; Outcome
• ISSN: 0019-6061; 0974-7559
• DOI: 10.1007/s13312-019-1639-7

Objective
Vasoactive-inotropic Score (VIS) was developed to quantify the amount of inotropic support provided in the postoperative period. We investigated the predictive value of (VIS) for mortality in neonates with congenital heart disease (CHD).
Study design
Prospective cohort.
Patients
119 newborns who underwent cardiac surgery.
Setting
Tertiary NICU-CHD center of Ankara from November 2016 to January 2019.
Intervention/Measurement
VIS values were calculated by a standard formula for the first 72 postoperative hours, and the maximum score was recorded.
Primary outcomes
Duration of mechanical ventilation, NICU length of stay, and mortality.
Results
At surgery, the median (IQR) age was 15 d (9–31). The patients were divided into two groups according to mortality; Group 1 (Non-survivors) (
n
=36) and Group 2 (Survivors) (
n
=83). Higher VIS score was correlated to longer duration of mechanical ventilation (
P
=0.009,
r
=0.33), and was higher among patients who died (
P
=0.003). Area under the curve (AUC) was 0,83 (
P
<.001, CI: 95% 0.7–0.9) for VIS to identify mortality. At a cut-off value of 15.5, sensitivity and negative predictive values of VIS for mortality were 73.6% and 85.3%, respectively. The higher VIS (>15.5) was independently associated with increased odds for mortality (OR: 8.1, 95% CI: 1.8–35.7,
P
=0.005).
Conclusions
In newborns with CHD, a higher VIS within 72 hours after cardiac surgery is associated with increased duration of mechanical ventilation, and mortality. VIS may be useful for prediction of mortality at early postoperative period.