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Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass

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Abstract

Purpose

The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery.

Methods

A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed “poor outcome”, which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation.

Results

After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51–18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10–2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28–2.74, p = 0.001).

Conclusions

The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults.

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Author information

Authors and Affiliations

  1. Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Yumiko Yamazaki & Yuji Morimoto

  2. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Koji Oba

  3. Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Yoshiro Matsui

Authors
  1. Yumiko Yamazaki
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  2. Koji Oba
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  3. Yoshiro Matsui
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  4. Yuji Morimoto
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Contributions

YY: this author designed, analyzed, and prepared manuscript. KO: this author helped to design the study and analyzed data. YM: this author helped to prepare manuscript. YM: this author helped to conduct the study and prepare manuscript.

Corresponding author

Correspondence to Yumiko Yamazaki.

Electronic supplementary material

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540_2018_2447_MOESM1_ESM.jpg

Supplement Figure 1. Receiver operating characteristic curve of vasoactive inotropic score. The area under the receiver operating curve was 0.77 and the optimal cutoff point of the VIS to determine the high and low VIS groups was 5.5, with sensitivity of 0.83 and specificity of 0.54. AUC, area under the curve (JPEG 19 kb)

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Yamazaki, Y., Oba, K., Matsui, Y. et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth 32, 167–173 (2018). https://doi.org/10.1007/s00540-018-2447-2

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  • DOI: https://doi.org/10.1007/s00540-018-2447-2

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