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Threshold of Inotropic Score and Vasoactive-Inotropic Score for Predicting Mortality in Pediatric Septic Shock
Dipu Kallekkattu1, Ramachandran Rameshkumar2, Muthu Chidambaram1
1Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Insights
The study identified thresholds for the inotropic score (IS) and vasoactive-inotropic score (VIS) to predict mortality in pediatric septic shock. Scores above 28 for IS and 42.5 for VIS were independently associated with increased mortality risk.
Area of Science:
- Pediatric critical care medicine
- Pediatric intensive care
- Septic shock management
Background:
- Pediatric septic shock requires vasoactive medications for hemodynamic support.
- Identifying reliable markers for mortality prediction in pediatric septic shock is crucial for timely intervention.
Purpose of the Study:
- To establish the predictive threshold values for the inotropic score (IS) and vasoactive-inotropic score (VIS) in pediatric septic shock.
- To assess the association of these scores with pediatric intensive care unit (PICU) mortality.
Main Methods:
- Retrospective cohort study of 176 children (1 month to 13 years) with septic shock requiring vasoactive medication.
- Calculation of Area Under the Curve Receiver Operating Characteristic (AUROC) for mean IS and VIS to predict PICU mortality.
- Determination of Youden index cut points, sensitivity, specificity, and binary regression analysis.
Main Results:
- The Area Under the Curve Receiver Operating Characteristic (AUROC) for IS was 0.80 and for VIS was 0.88 in predicting PICU mortality.
- The optimal cutoff scores were IS > 28 and VIS > 42.5.
- Illness severity (PRISM-III), worst lactate value, IS > 28, and VIS > 42.5 independently predicted PICU mortality.
Conclusions:
- Thresholds of IS > 28 and VIS > 42.5 are independently associated with PICU mortality in pediatric septic shock.
- In addition to IS and VIS, illness severity and worst lactate levels are independent predictors of mortality.
- These scores can aid in risk stratification and management decisions for pediatric septic shock.
Objective:
To determine the threshold of the inotropic score (IS) and vasoactive-inotropic score (VIS) for predicting mortality in pediatric septic shock.
Method:
This retrospective cohort study included children aged 1 mo to 13 y with septic shock, requiring vasoactive medication. The area under curve receiver operating characteristic (AUROC) was calculated using mean IS and mean VIS to predict PICU mortality, and Youden index cut points were generated. Sensitivity, specificity, and binary regression analysis were performed.
Results:
A total of 176 patients were enrolled (survivor, n = 72, 41% and nonsurvivor, n = 104, 59%). For predicting the PICU mortality, AUROC (95% CI) of IS was 0.80 (0.74-0.86) [sensitivity of 88.5 (80.7-94) and specificity of 58.3 (46.1-69.8)] and AUROC of VIS was 0.88 (0.82-0.92) [sensitivity of 83.7 (75.1-90.2) and specificity of 80.6 (69.5-89)]. The respective cutoff scores of IS and VIS were 28 and 42.5. On regression analysis (adjusted odds ratio, 95% CI), illness severity (PRISM-III) (1.12, 1.05-1.12), worst lactate value (1.31, 1.08-1.58), IS (> 28) (3.98, 1.24-12.80), and VIS (> 42.5) (4.66, 1.57-13.87) independently predicted the PICU mortality (r2 = 0.625).
Conclusion:
Threshold of inotropic score (> 28) and vasoactive-inotropic score (> 42.5) were independently associated with PICU mortality. In addition to IS and VIS, severity and worst lactate value independently predicted septic shock mortality in PICU.
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