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Vasoactive-ventilation-renal score in predicting outcome postcardiac surgery in children

Shahzad Alam1, Shalini Akunuri2, Akanksha Jain3

  • 1Pediatric Cardiac Evaluation and Cardiac Surgery Unit, J. N. Medical College, Aligarh, Uttar Pradesh, India.

International Journal of Critical Illness and Injury Science
|September 6, 2018
PubMed

Insights

The vasoactive-ventilation-renal (VVR) score effectively predicts outcomes after pediatric cardiac surgery. This score, particularly at 48 hours post-operation, is a robust bedside tool for identifying prolonged intensive care unit stays and mortality risk.

Area of Science:

  • Pediatric cardiac surgery outcomes research
  • Intensive care unit (ICU) management
  • Clinical scoring systems in pediatrics

Background:

  • Predicting outcomes after pediatric cardiac surgery is crucial for resource allocation and patient management.
  • Existing scores like the vasoactive-inotropic score (VIS) have limitations in predicting complex outcomes.
  • The vasoactive-ventilation-renal (VVR) score is a novel composite score for assessing post-surgical pediatric patients.

Purpose of the Study:

  • To evaluate the efficacy of the VVR score in predicting outcomes in children following cardiac surgery.
  • To determine the optimal time point for utilizing the VVR score to predict outcomes.
  • To compare the predictive performance of the VVR score against the vasoactive-inotropic score (VIS).

Main Methods:

  • A prospective cohort study included 1097 children (≤18 years) undergoing cardiac surgery for congenital heart disease.
  • Vasoactive-ventilation-renal (VVR) and vasoactive-inotropic scores (VIS) were calculated at admission, 24 hours, and 48 hours postoperatively.
  • Outcomes assessed were prolonged ICU length of stay (LOS) and ICU mortality, analyzed using correlation and receiver operating characteristic (ROC) curves.

Main Results:

  • The VVR score demonstrated superior correlation with outcomes and higher area under the curve (AUC) compared to VIS at all time points.
  • The VVR score at 48 hours post-surgery showed the highest predictive accuracy for prolonged ICU LOS (AUC=0.87) and mortality (AUC=0.92).
  • The 48-hour VVR score was strongly associated with prolonged LOS (OR=1.24) and mortality (OR=1.16).

Conclusions:

  • The VVR score is a reliable and practical bedside method for predicting prolonged ICU length of stay and mortality in pediatric cardiac surgery patients.
  • The VVR score calculated at 48 hours postoperatively is the most effective time point for outcome prediction.
  • This scoring system aids in early identification of high-risk patients, enabling timely interventions.
Abstract

Keywords:
Cardiac surgical proceduresIntensive Care Unit pediatricscritical care outcomehospital mortality

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