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Vascular Reactivity Index and PELOD-2 as a mortality predictor in paediatric septic shock: a single-centre
Irene Yuniar1, Utami Kurniawati Setianingsih2, Sudung O Pardede1
1Department of Pediatrics, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia.
Background:
The mortality rate for children with septic shock is stil quite high in low-income and middle-income countries (31.7%). One of the most widely used scoring systems to assess mortality in sepsis or septic shock is Paediatric Logistic Organ Dysfunction 2 (PELOD-2). However, it requires various laboratory evaluations. A non-invasive, fast and easy method is needed to assess the mortality of children with septic shock at an early stage. Therefore, this study aims to evaluate the ability of Vascular Reactivity Index (VRI) compared with PELOD-2 score as a predictor of mortality in children with septic shock based on vascular response to vasoactive agents.
Methods:
A retrospective cohort study was conducted using data from children aged 1 month to 18 years with septic shock treated in the ER and paediatric intensive care unit (PICU) of the tertiary hospital from 2017 to 2021. The serial haemodynamic data were analysed including Systemic Vascular Resistant Index (SVRI) and the cardiac index from ultrasound cardiac output monitoring device was recorded in the first and sixth hours after the diagnosis of septic shock. The VRI was determined by dividing SVRI/Vasoactive Inotropic Score (ie, accumulated doses of dopamine, dobutamine, epinephrine, milrinone, vasopressin and norepinephrine). The receiver operating curve was used to calculate the area under the curve (AUC), sensitivity and specificity of each cut-off point.
Results:
A total of 68 subjects fulfilled the inclusion and exclusion criteria, the median age was 54 months with a range of 2-204 months and the mortality rate was 47%. The majority of the patients who died were found in the high cardiac index and low SVRI group (17.6%). Moreover, the optimum cut-off point of VRI was obtained to predict mortality in septic shock of 32.1, with 87.5% sensitivity and 88.9% specificity. The AUC for predicting death using VRI was 95% (95% CI 90% to 100%, p<0.001) and PELOD-2 92.6% (95% CI 96.4% to 98.8%, p<0.001).
Conclusion:
The VRI <32.1 may potentially be used to predict mortality in children with septic shock and its predictive ability is as good as PELOD-2. The assessment of VRI is faster and easier than PELOD-2.
