Requiring vasoactive drugs within 1 hour of cardiac ICU admission was associated with higher in-hospital mortality (adjusted OR 1.30; 95% CI 1.03-1.65; P=0.03).
Cohort (n=9,916)
No
Does a higher vasoactive-inotropic score (VIS) predict in-hospital mortality in cardiac intensive care unit patients?
The vasoactive-inotropic score provides incremental prognostic information beyond the SCAI Shock Classification for predicting in-hospital mortality in cardiac ICU patients.
Effect estimate: adjusted OR 1.30 (95% CI 1.03-1.65)
p-value: p=0.03
ABSTRACT: Background: The Society for Cardiovascular Angiography and Intervention (SCAI) Shock Classification can define shock severity. We evaluated the vasoactive-inotropic score (VIS) combined with the SCAI Shock Classification for mortality risk stratification. Methods: This was a single-center retrospective cohort analysis including Mayo Clinic cardiac intensive care unit patients from 2007 to 2015. The peak VIS was calculated at 1 and 24 h after cardiac intensive care unit admission. In-hospital mortality was evaluated using multivariable logistic regression. Results: Of 9,916 included patients, vasoactive drugs were used in 875 (8.8%) within 1 h and 2,196 (22.1%) within 24 h. A total of 888 patients (9.0%) died during hospitalization. Patients who required vasoactive drugs within 1 h had higher in-hospital mortality (adjusted odds ratio OR, 1.30; 95% confidence interval CI, 1.03-1.65; P = 0.03) and in-hospital mortality rose with the VIS during the first 1 h (adjusted OR per 10 units, 1.22; 95% CI, 1.12-1.33; P < 0.001). The increase in VIS from 1 to 24 h was associated with higher in-hospital mortality (adjusted OR per 10 units, 1.16; 95% CI, 1.10-1.21; P < 0.001). These results were consistent in the 1,067 patients (10.9%) with cardiogenic shock. A gradient of in-hospital mortality was observed according to the VIS at 1 h and the increase in VIS from 1 to 24 h. Conclusions: Higher vasoactive drug requirements portend a higher risk of mortality, particularly a high VIS early after admission. The VIS provides incremental prognostic information beyond the SCAI Shock Classification, emphasizing the continuum of risk that exists across the spectrum of shock severity.
Jentzer et al. (Mon,) conducted a cohort in Cardiac intensive care unit patients (n=9,916). Vasoactive drugs within 1 h vs. No vasoactive drugs within 1 h was evaluated on In-hospital mortality (adjusted OR 1.30, 95% CI 1.03-1.65, p=0.03). Requiring vasoactive drugs within 1 hour of cardiac ICU admission was associated with higher in-hospital mortality (adjusted OR 1.30; 95% CI 1.03-1.65; P=0.03).