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Comparison of Predictive Powers for Mortality between Systemic Vascular Resistance Index and Serum Lactate in
En-Pei Lee1,2, Sheng-Chih Chu3,4, Shao-Hsuan Hsia1,2
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
Insights
Systemic vascular resistant index (SVRI) predicts mortality in pediatric persistent catecholamine-resistant shock. Lower SVRI levels in the first 24 hours indicate higher mortality risk, while higher levels suggest better outcomes.
Area of Science:
- Pediatric critical care medicine
- Hemodynamic monitoring
- Shock management
Background:
- Persistent catecholamine-resistant shock in children is associated with high morbidity and mortality.
- Early identification of prognostic factors is crucial for improving outcomes in pediatric shock.
Purpose of the Study:
- To analyze the association between hemodynamic parameters, serum lactate, and 28-day mortality in children with persistent catecholamine-resistant shock.
- To identify early predictors of mortality in this vulnerable pediatric population.
Main Methods:
- Retrospective analysis of 26 children with persistent catecholamine-resistant shock.
- Hemodynamic monitoring using pulse index continuous cardiac output.
- Serial analysis of cardiac index (CI), systemic vascular resistant index (SVRI), and vasoactive-inotropic score (VIS) within the first 24 hours.
Main Results:
- The 28-day mortality rate was 53.8%.
- Systemic vascular resistant index (SVRI) and vasoactive-inotropic score (VIS) were independent predictors of mortality.
- Lower serial SVRI and higher VIS were observed in non-survivors. SVRI demonstrated a strong negative correlation with serum lactate (r = -0.711) and outperformed lactate in predicting mortality.
Conclusions:
- Systemic vascular resistant index (SVRI) is an early predictor of mortality in pediatric persistent catecholamine-resistant shock.
- An SVRI exceeding 1284 dyn·s·cm⁻⁵·m² within the first 24 hours is associated with favorable outcomes.
- Findings suggest SVRI may be a more powerful prognostic indicator than lactate, though caution is advised due to the small sample size.
Abstract:
Persistent catecholamine-resistant shock in children causes severe morbidity and mortality. We aimed to analyze the association between hemodynamics and serum lactate at different time points and 28-day mortality in children with persistent catecholamine-resistant shock. Methods. Twenty-six children with persistent catecholamine-resistant shock were enrolled, and their hemodynamics were monitored using the pulse index continuous cardiac output. Serial cardiac index (CI), systemic vascular resistant index (SVRI), and vasoactive-inotropic score (VIS) were analyzed for the first 24 hours. Associations between hemodynamics, serum lactate, and 28-day mortality were analyzed. Results. The 28-day mortality rate was 53.8%. SVRI and VIS were independent predictors of 28-day mortality. The mortality group had lower serial SVRI and higher VIS than the survival group (p < 0.05). Serial SVRI had the highest area under the receiver operating characteristic curve (AUC) for predicting mortality during the first 24 hours of persistent catecholamine-resistant shock. Three important hemodynamic parameters, CI, SVRI and perfusion pressure (MAP-CVP), were significantly correlated with lactate, of which SVRI had the best correlation (r = -0.711, p < 0.001). According to the AUC, SVRI was a more powerful predictor of mortality than lactate in persistent catecholamine-resistant shock. After 24 hours of treatment for persistent catecholamine-resistant shock, an SVRI lower than 1284 dyn·s·cm-5·m2 was associated with 28-day mortality. Conclusions. SVRI was an early factor associated with mortality in the pediatric patients with persistent catecholamine-resistant shock potentially and had the good correlation with serum lactate. An SVRI more than 1284 dyn·s·cm-5·m2 during the first 24 hours of persistent catecholamine-resistant shock was associated with favorable outcomes. The result should be used with caution due to the small sample size.
