Yumiko Yamazaki1, Koji Oba2, Yoshiro Matsui3, Yuji Morimoto4. 1. Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. chomy127@gmail.com. 2. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 4. Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Abstract
PURPOSE: The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery. METHODS: A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed "poor outcome", which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation. RESULTS: After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51-18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10-2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28-2.74, p = 0.001). CONCLUSIONS: The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults.
PURPOSE: The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery. METHODS: A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed "poor outcome", which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation. RESULTS: After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51-18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10-2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28-2.74, p = 0.001). CONCLUSIONS: The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults.
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