Vasoactive-Inotropic Score as a Predictor of Outcomes in Children with Fluid-Refractory Septic Shock Admitted to the Pediatric Intensive Care Unit of a Tertiary Care Center

Background: The Vasoactive-Inotropic Score (VIS) has been proposed as a simple marker of illness severity and predictor of outcomes in pediatric critical illness. However, its prognostic role in pediatric septic shock remains incompletely studied. This study aimed to evaluate the predictive value of VIS for mortality and morbidity in children with fluid-refractory septic shock. Methods: A prospective observational study was conducted on 68 children admitted with fluid-refractory septic shock to the PICU of a tertiary care center between January 2021 and June 2022. VIS was calculated at predefined intervals and maximum VIS values were recorded. Outcomes assessed included mortality, length of PICU stay and duration of mechanical ventilation. VIS performance was compared with PRISM-IV score and lactate clearance. Results: High VIS values were significantly associated with mortality and mechanical ventilation. A cut-off value of >70 demonstrated strong predictive accuracy for mortality. Higher PRISM-IV scores and poor lactate clearance at 6 hours were also independently associated with adverse outcomes. Notably, non-survivors had shorter PICU stays due to early mortality. Conclusion: VIS was independently predictive of mortality and adverse outcomes in pediatric septic shock and outperformed PRISM-IV in prognostic accuracy. Incorporation of VIS into clinical protocols may enable timely identification of high-risk children. Multicenter studies with larger cohorts are warranted for external validation.