Journal of cardiothoracic and vascular anesthesia · 2026
Associations Between Early Vasoactive Inotrope Score Trajectories and Clinical Outcomes in Postcardiotomy Cardiogenic Shock Patients: A Retrospective Cohort Analysis.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Su Qinyue, Tang Bo, Li Wenxin, Liu Shengjun, Long Yun
Аннотация
OBJECTIVE: To hypothesize that vasoactive-inotropic score (VIS) trajectories following cardiac surgery are independently associated with 30-day all-cause mortality after intensive care unit (ICU) admission, with higher VIS trajectories correlating with worse outcomes in terms of mortality and organ dysfunction.
DESIGN: A single-center, retrospective, observational study.
SETTING: An adult ICU in a tertiary hospital.
PARTICIPANTS: A total of 1,654 postcardiotomy cardiogenic shock (PCCS) patients admitted to the surgical ICU between July 2013 and June 2024.
INTERVENTIONS: Retrospective collection and analysis of patients' clinical data were conducted.
MEASUREMENTS AND MAIN RESULTS: Hourly VIS values were calculated during the first 72 hours after ICU admission. Latent class mixed modeling identified 4 distinct VIS trajectory classes from 1,654 PCCS patients: low-level transient rise (class 1, 23.6%), high-level peak-and-decline (class 2, 19.2%), high-level rapid decline (class 3, 18.9%), and low-level steady decline (class 4, 38.3%). Multivariable Cox analysis showed that class 2 was independently associated with increased 30-day all-cause mortality after ICU admission compared with class 4 (adjusted hazard ratio 2.67, 95% confidence interval 1.20-5.97), while no significant association was observed for classes 1 and 3. Class 2 also exhibited the most severe organ dysfunction, including the highest incidence and severity of acute kidney injury, elevated liver biomarkers (alanine aminotransferase and total bilirubin), a higher Sequential Organ Failure Assessment score, persistently impaired peripheral perfusion, and delayed lactate normalization. Notably, among patients with similar initial VIS levels, increasing trajectories (classes 2 and 3) were associated with worse outcomes compared with decreasing trajectories (classes 1 and 4).
CONCLUSIONS: The initial 72-hour VIS trajectory stratifies patients with PCCS into 4 distinct classes, which correlate with different clinical outcomes. These findings suggest that VIS trajectory may serve as a risk stratification indicator, providing valuable insights into predicting disease progression and individualized therapy for PCCS patients.
DESIGN: A single-center, retrospective, observational study.
SETTING: An adult ICU in a tertiary hospital.
PARTICIPANTS: A total of 1,654 postcardiotomy cardiogenic shock (PCCS) patients admitted to the surgical ICU between July 2013 and June 2024.
INTERVENTIONS: Retrospective collection and analysis of patients' clinical data were conducted.
MEASUREMENTS AND MAIN RESULTS: Hourly VIS values were calculated during the first 72 hours after ICU admission. Latent class mixed modeling identified 4 distinct VIS trajectory classes from 1,654 PCCS patients: low-level transient rise (class 1, 23.6%), high-level peak-and-decline (class 2, 19.2%), high-level rapid decline (class 3, 18.9%), and low-level steady decline (class 4, 38.3%). Multivariable Cox analysis showed that class 2 was independently associated with increased 30-day all-cause mortality after ICU admission compared with class 4 (adjusted hazard ratio 2.67, 95% confidence interval 1.20-5.97), while no significant association was observed for classes 1 and 3. Class 2 also exhibited the most severe organ dysfunction, including the highest incidence and severity of acute kidney injury, elevated liver biomarkers (alanine aminotransferase and total bilirubin), a higher Sequential Organ Failure Assessment score, persistently impaired peripheral perfusion, and delayed lactate normalization. Notably, among patients with similar initial VIS levels, increasing trajectories (classes 2 and 3) were associated with worse outcomes compared with decreasing trajectories (classes 1 and 4).
CONCLUSIONS: The initial 72-hour VIS trajectory stratifies patients with PCCS into 4 distinct classes, which correlate with different clinical outcomes. These findings suggest that VIS trajectory may serve as a risk stratification indicator, providing valuable insights into predicting disease progression and individualized therapy for PCCS patients.