Key result
Postoperative VIS over 4.1 at 48 hours is linked to ~3.4-fold higher endocarditis surgical mortality.
Why the study?
The study aimed to evaluate the predictive value of the vasoactive inotropic score in the postoperative management of patients undergoing valve surgery for infective endocarditis.
Does the vasoactive inotropic score (VIS) predict mortality in patients undergoing valve surgery for infective endocarditis?
Cohort (n=334)
No
Does the vasoactive inotropic score (VIS) predict mortality in patients undergoing valve surgery for infective endocarditis?
The vasoactive inotropic score at 48 hours postoperatively is a strong, independent predictor of mortality in patients undergoing valve surgery for infective endocarditis, outperforming conventional markers like lactate and ScvO2.
Answers are grounded in this paper and cite their sources.
May support VIS for postoperative risk stratification in endocarditis surgery; hypothesis-generating pending prospective validation.
The study aimed to analyze the predictive value of the vasoactive inotropic score (VIS) in the postoperative treatment of patients undergoing valve surgery for infective endocarditis (IE). At our institution, 334 patients underwent valve surgery for IE from 01/2016 to 12/2022. Patients with postoperative MCS device were excluded from this study. Data are presented as medians and 25th - 75th percentiles, or absolute numbers and percentages. Non-survivors had a significantly higher EuroSCORE II preoperatively (4.5 (2.3-9.8)% vs. 12.6 (5.7-20.9)%, p < 0.001). In non-survivors, Staphylococcus (89 (32.1%) vs. 20 (54.1%), p = 0.01) and Staphylococcus aureus (62 (22.4%) vs. 14(37.8%), p = 0.064) were significantly more frequently identified as causative pathogens. Non-survivors had significantly higher IL-6 levels at POD 1, 2 and 4 compared to survivors (p < 0.021). Non survivor had significantly higher VIS immediately postoperatively as well as 6 h, 12 h, 24 h, 36 h and 48 h after surgery. In addition, VIS at 48 h was identified as an independent variable associated with non-survival at values > 4.1. When comparing the ROC of lactate, ScvO2 and VIS after 48 h, VIS showed the highest AUC. The VIS is particularly suitable for patients with infective endocarditis due to combined assessment of postoperative cardiovascular dysfunction and IE related inflammatory response. We provided suggestive evidence that the amount of cardiovascular support represented as the VIS has a predictive value regarding mortality in patients undergoing valve replacement for IE. In addition, VIS showed superiority compared to conventional scoring systems for predicting outcome in the intensive care of postoperative IE patients.
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Schnackenburg et al. (2025) conducted a cohort in Infective endocarditis (n=334). Vasoactive inotropic score (VIS) > 4.1 vs. VIS ≤ 4.1 was evaluated on Non-survival (mortality) (OR 3.430, 95% CI 1.212-9.710, p=0.020). A vasoactive inotropic score greater than 4.1 at 48 hours postoperatively was independently associated with increased mortality (OR 3.43) in patients undergoing valve surgery for infective endocarditis.
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