Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care

Area of Science:

• Critical Care Medicine
• Clinical Scoring Systems
• Prognostic Biomarkers

Background:

• The cardiovascular component of the Sequential Organ Failure Assessment (cvSOFA) score may be outdated due to evolving intensive care practices.
• The Vasoactive Inotropic Score (VIS) quantifies the use of vasoactive and inotropic drugs, reflecting cardiovascular support intensity.

Purpose of the Study:

• To investigate the association between VIS and mortality in the general ICU population.
• To determine if replacing cvSOFA with a VIS-based score enhances the accuracy of the SOFA score in predicting mortality.

Main Methods:

• A retrospective study analyzed 8079 adult patients admitted to Kuopio University Hospital ICU (2013-2019).
• The association of VIS within the first 24 hours with 30-day mortality was examined.
• Area Under the Receiver Operating Characteristic Curve (AUROC) was calculated for the original SOFA score and a modified SOFA score (SOFAVISmax), where cvSOFA was replaced by VISmax categories.

Main Results:

• A total of 1107 patients (13%) died within 30 days.
• Mortality demonstrated a consistent increase with higher VISmax categories.
• SOFAVISmax (AUROC: 0.822) showed improved predictive accuracy compared to the original SOFA score (AUROC: 0.813), with statistical significance (p < 0.001).

Conclusions:

• Increasing VISmax is consistently associated with higher mortality rates.
• Replacing the cvSOFA component with VISmax in the SOFA score significantly improves its predictive accuracy for mortality in the ICU.