Using Vasoactive-Ventilation-Renal Score in Pediatric Heart Failure Cases as a Predictor of an Extended Intensive Care Unit Stay

Background: The vasoactive-ventilation-renal (VVR) score is a disease severity index for predicting outcomes of pediatric patients receiving cardiac surgeries. We investigated whether the VVR score on admission can predict the length of stay (LOS) in the pediatric intensive care unit (PICU) in children diagnosed with heart failure (HF). Methods: Medical records were reviewed for pediatric HF cases between January 2010 and December 2016. We calculated the VVR score using the electronic data, including measurements obtained at the time of admission and analyzed the correlation between the VVR score and prolonged LOS (PLOS). A PLOS was defined by a longer stay than the median duration for the surviving cases. Results: A total of 113 pediatric HF cases were reviewed, of which 96 cases were finally included in the study. The median [IQR] LOS was 12 [6, 22] days. The use of a mechanical ventilator and extracorporeal membrane oxygenation (ECMO) were associated with PLOS. The area under the curve (AUC) of the vasoactive-inotropic score (VIS), VVR score, lactic acid level, and brain natriuretic peptide (BNP) for evaluating the association with mechanical ventilator or ECMO use was 0.682 (P = 0.006), 0.823 (P < 0.001), 0.683 (P = 0.006), and 0.783 (P < 0.001), respectively. In multivariable logistic regression analysis, the VVR score was the only significant parameter for predicting PLOS. Conclusions: The VVR score on admission to the PICU is predictive for mechanical ventilator or ECMO use, which correlates with a PLOS. Therefore, the VVR score at PICU admission in children with HF is a useful LOS marker.