Vasoactive-inotropic Score As A Predictor Of Outcome In Children After Cardiac-surgury With Bypass

Objective: To evaluate the vasoactive-inotropic score(VIS)as a predictor of outcome in children following surgery for congenital heart disease.Methods: 1.A retrospective chart review of 472 children in the Children's Hospital of Chongqing Medical University from March 2014 to March 2015 undergoing cardiac surgery with bypass.VIS values were calculated during the first 72 postoperative hours,and the maximum and mean scores in the first,second and third 24 postoperative hours[VIS(24max),VIS(24mean),VIS(48max),VIS(48mean),VIS(72max),VIS(72mean)] were also recorded.2.Chi-test,t-test,ROC curves,rank-sum test and Logistic regression analyze were performed for the association between VIS and the clinical outcomes.Results: 1.There were 16 cases of neonates(16/472,3.39%),87 cases of complex congenital heart disease eliminated atrial septal defect(ASD),and ventricular septal defect(VSD)(87/472,18.43%),[5 case of complete atrioventricular septal defect(CAVC),21 case of double outletof right ventricle(DORV),6 cases of translocation of great arteries(TGA),1case of pulmonary valve atresia(PVA),10 cases of total anomalous pulmonary venous connection(TAPVC),5 cases of partial anomalous pulmonary venous connection(PAPVC),2 cases of single ventricle(SV),37 cases of tetralogy of Fallot(TOF)].Children who reached poor outcomes included 15 cases of death(15/472,3.18%),11 cases of neurologic injury(11/472,2.33%),16 cases of cardio-pulmonary resuscitation(16/472,3.18%)and 15 cases of hemodialysis(15/472,7.56%).2.ROC analysis indicated the VIS(24max)was strongly associated with poor outcomes(AUROC=0.919,P=0.000).And the high VIS(24max)defined as 19.5 and above,which may lead poor outcomes(J=0.70).3.Body weight,high lactic acid value,the use time of vascular active drug,whether low cardiac output syndrome occurred after surgery,surgical risk classification,VIS score,age,aortic cross clamp time,cardiopulmonary bypass time are associated with the prognosis of children.However,after controlling the interaction between multiple single factors,Logistic regression analysis showed that only lactate and VIS(24max)were related to the prognosis of children.Conclusion: Maximum VIS calculated in the first 24hours[VIS(24max)] after PICU admission was strongly and significantly associated with clinical outcomes in children after cardiac surgery.The greater the VIS,the worse the illness,the poorer the outcome,the higher the mortality.