Heart & lung : the journal of critical care · 2025
Early vasoactive-inotropic score kinetics predict low cardiac output syndrome and acute kidney injury after infant cardiac surgery: a retrospective cohort study.
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Al-Murad Abdullah, Hilmi Ibtesam
Аннотация
BACKGROUND: Infants recovering from congenital heart surgery risk complications such as low cardiac output syndrome (LCOS) and acute kidney injury (AKI). Although clinicians use the vasoactive-inotropic score (VIS) to assess cardiovascular support, relying only on the peak value (VIS-max) may overlook meaningful changes in vasoactive requirements during early recovery.
OBJECTIVE: This study evaluated whether early VIS kinetics-captured through the area under the curve (VIS-AUC₀-₁₂h) and the rate of change (VIS-slope₀-₁₂h)-offer better prediction of LCOS and AKI compared with VIS-max.
METHODS: We retrospectively reviewed 320 infants under 24 months undergoing congenital heart surgery with cardiopulmonary bypass. Vasoactive doses from the first 12 postoperative hours were used to calculate VIS-max, VIS-AUC, and VIS-slope. LCOS and AKI were defined using standardized criteria. Predictive performance was evaluated with multivariable logistic regression and cross-validated AUCs.
RESULTS: Among 320 infants, 31.6% developed LCOS and 10.3% developed AKI. Infants with LCOS showed higher VIS-max, greater VIS-AUC₀-₁₂h, and steeper VIS-slope trajectories than those without LCOS. VIS kinetics provided modest but consistent improvement in LCOS prediction over VIS-max (AUC 0.760 vs 0.746), and decision-curve analysis indicated additional net clinical benefit. In contrast, VIS metrics showed limited discrimination for AKI.
CONCLUSIONS: Monitoring VIS trends during early postoperative hours offers a broader assessment of circulatory stress than relying solely on VIS-max. Early VIS kinetics may help identify infants at higher risk of LCOS and support closer hemodynamic surveillance, while their limited value for AKI suggests a need for additional renal risk markers.
OBJECTIVE: This study evaluated whether early VIS kinetics-captured through the area under the curve (VIS-AUC₀-₁₂h) and the rate of change (VIS-slope₀-₁₂h)-offer better prediction of LCOS and AKI compared with VIS-max.
METHODS: We retrospectively reviewed 320 infants under 24 months undergoing congenital heart surgery with cardiopulmonary bypass. Vasoactive doses from the first 12 postoperative hours were used to calculate VIS-max, VIS-AUC, and VIS-slope. LCOS and AKI were defined using standardized criteria. Predictive performance was evaluated with multivariable logistic regression and cross-validated AUCs.
RESULTS: Among 320 infants, 31.6% developed LCOS and 10.3% developed AKI. Infants with LCOS showed higher VIS-max, greater VIS-AUC₀-₁₂h, and steeper VIS-slope trajectories than those without LCOS. VIS kinetics provided modest but consistent improvement in LCOS prediction over VIS-max (AUC 0.760 vs 0.746), and decision-curve analysis indicated additional net clinical benefit. In contrast, VIS metrics showed limited discrimination for AKI.
CONCLUSIONS: Monitoring VIS trends during early postoperative hours offers a broader assessment of circulatory stress than relying solely on VIS-max. Early VIS kinetics may help identify infants at higher risk of LCOS and support closer hemodynamic surveillance, while their limited value for AKI suggests a need for additional renal risk markers.