Front Pediatr. 2022 Mar 4;10:778378. doi: 10.3389/fped.2022.778378. eCollection 2022.
ABSTRACT
OBJECTIVES: The heterogeneity of sepsis makes it difficult to predict outcomes using existing severity of illness tools. The vasoactive-inotrope score (VIS) is a quantitative measure of the amount of vasoactive support required by patients. We sought to determine if a higher aggregate VIS over the first 96 h of vasoactive medication initiation is associated with increased resource utilization and worsened clinical outcomes in pediatric patients with severe sepsis.
DESIGN: Retrospective cohort study.
SETTING: Single-center at Children’s Wisconsin in Milwaukee, WI.
PATIENTS: One hundred ninety-nine pediatric patients, age less than 18 years old, diagnosed with severe sepsis, receiving vasoactive medications between January 2017 and July 2019.
INTERVENTIONS: Retrospective data obtained from the electronic medical record, calculating VIS at 2 h intervals from 0-12 h and at 4 h intervals from 12-96 h from Time 0.
MEASUREMENTS: Aggregate VIS derived from the hourly VIS area under the curve (AUC) calculation based on the trapezoidal rule. Data were analyzed using Pearson’s correlations, Mann-Whitney test, Wilcoxon signed rank test, and classification, and regression tree (CART) analyses.
MAIN RESULTS: Higher aggregate VIS is associated with longer hospital LOS (p < 0.0001), PICU LOS (p < 0.0001), MV days (p = 0.018), increased in-hospital mortality (p < 0.0001), in-hospital cardiac arrest (p = 0.006), need for ECMO (p < 0.0001), and need for CRRT (p < 0.0001). CART analyses found that aggregate VIS >20 is an independent predictor for in-hospital mortality (p < 0.0001) and aggregate VIS >16 for ECMO use (p < 0.0001).
CONCLUSIONS: There is a statistically significant association between aggregate VIS and many clinical outcomes, allowing clinicians to utilize aggregate VIS as a physiologic indicator to more accurately predict disease severity/trajectory in pediatric sepsis.
PMID:35311061 | PMC:PMC8931266 | DOI:10.3389/fped.2022.778378
