Key result
Higher vasoactive-inotropic score is linked to ~6% higher 90-day mortality per 10-point increase.
Why the study?
Despite high mortality and traditional stratification by SCAI staging, substantial heterogeneity remains within stages, and whether vasoactive therapy intensity or combination adds prognostic value beyond SCAI staging is unknown.
Does vasoactive support intensity quantified by the vasoactive-inotropic score (VIS) improve 90-day mortality prediction beyond SCAI staging in adults with cardiogenic shock?
Cohort (n=1,167)
Yes
Does vasoactive support intensity quantified by the vasoactive-inotropic score (VIS) improve 90-day mortality prediction beyond SCAI staging in adults with cardiogenic shock?
Odds Ratio: 1.06 (95% CI 1.04–1.07)
p-value: p=<0.001
The vasoactive-inotropic score (VIS) provides significant incremental prognostic value for 90-day mortality beyond standard SCAI staging in patients with cardiogenic shock.
VIS may refine 90-day mortality prediction in cardiogenic shock beyond SCAI staging; leaves open prospective validation before routine use.
Background Cardiogenic shock (CS) remains associated with high mortality. Severity is traditionally stratified by the SCAI staging system despite substantial heterogeneity within stages. Whether vasoactive therapy intensity or combination provides additional prognostic information beyond SCAI staging remains unknown. This study assessed whether vasoactive support intensity, quantified by the vasoactive–inotropic score (VIS), improves mortality prediction beyond SCAI staging. Methods In this retrospective bicentric cohort, consecutive adults admitted for CS between 2018 and 2023 were included. The VIS was calculated. The primary outcome was 90-day mortality. Multivariable logistic regression models adjusted for baseline severity assessed interactions with SCAI stage and the incremental prognostic value of VIS using nested models. Results Among 1,167 patients, 90-day mortality increased across SCAI stages C, D, and E (20.1%, 27.4%, and 45.6%; p<0.001, respectively), with substantial heterogeneity within stages. In stage C, dobutamine alone was associated with lower mortality than norepinephrine alone (OR=0.25[0.09–0.74]; p=0.009); in stage E, dobutamine plus norepinephrine was associated with higher mortality (OR=2.39[1.07–5.36]; p=0.028). The number of vasoactive agents was associated with mortality (OR=1.27 per additional agent; p=0.041) but proved a crude marker, providing only marginal incremental discrimination (R2=0.233; Δ=+0.011), with its prognostic information fully captured by VIS (R2=0.286 vs 0.287 with and without number of agents). Adding SCAI stage minimally improved discrimination (R2=0.222 to 0.226; Δ=+0.004), whereas VIS substantially improved model performance (R2=0.286; Δ=+0.060;p<0.001). Conclusion Vasoactive intensity quantified by the vasoactive–inotropic score improved 90-day mortality prediction beyond SCAI staging and the simple count of vasoactive drugs, providing incremental prognostic information beyond SCAI staging.
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Beyls et al. (2026) conducted a cohort in Cardiogenic shock (n=1,167). Vasoactive-inotropic score (VIS) vs. SCAI staging alone was evaluated on 90-day all-cause mortality (OR 1.06 per 10-point increase, 95% CI 1.04-1.07, p=<0.001). Higher vasoactive intensity, quantified by the vasoactive-inotropic score, was independently associated with 90-day mortality (OR 1.06 per 10-point increase) and improved prediction beyond SCAI staging.
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