Vasoactive-Inotropic Score (VIS) and Outcome of Children with Pediatric Septic Shock

Area of Science:

• Pediatric Critical Care Medicine
• Pediatric Infectious Diseases
• Clinical Pharmacology

Background:

• Pediatric sepsis and septic shock are significant causes of mortality and morbidity in children.
• Accurate and early risk stratification is crucial for optimizing treatment and improving outcomes in pediatric septic shock.
• Existing scoring systems may have limitations in predicting outcomes in this vulnerable population.

Purpose of the Study:

• To evaluate the effectiveness of the vasoactive-inotropic score (VIS) in predicting clinical outcomes for children with sepsis.
• To determine the predictive accuracy of VIS and aggregate VIS (AVIS) for mortality and other key outcomes in pediatric septic shock.
• To identify a specific AVIS threshold for early risk stratification.

Main Methods:

• A prospective observational study was conducted over one year in a tertiary pediatric intensive care unit (PICU).
• Children aged 1 month to 12 years with fluid-refractory septic shock were enrolled.
• VIS and AVIS were calculated at multiple time points (6, 12, 24, 48, 72, 96 hours); primary outcome was mortality, secondary outcomes included PICU stay, ventilation, and inotrope duration.

Main Results:

• Ninety patients were enrolled; 58 (64.4%) were non-survivors.
• Aggregate VIS at 96 hours (AVIS96) strongly correlated with lactate levels (r=0.79), inotrope support duration (r=0.73), and ventilation duration (r=0.69).
• An AVIS96 cutoff of ≥25.4 demonstrated high accuracy (AUC 0.976, sensitivity 95%, specificity 90%) for predicting mortality, outperforming pSOFA and lactate.

Conclusions:

• The vasoactive-inotropic score (VIS) is a reliable predictor of outcomes in pediatric septic shock.
• Aggregate VIS at 96 hours (AVIS96) shows significant potential for early risk stratification.
• An AVIS96 cutoff value of 25.4 offers maximum diagnostic accuracy for mortality prediction in this pediatric cohort.