Early vasoactive-inotropic score kinetics predict low cardiac output syndrome and acute kidney injury after infant cardiac surgery: a retrospective cohort study
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View abstract on PubMed
Summary
This summary is machine-generated.Monitoring vasoactive-inotropic score (VIS) trends in infants after heart surgery, not just peak values, better predicts low cardiac output syndrome (LCOS). Early VIS kinetics improve LCOS risk assessment, but additional markers are needed for acute kidney injury (AKI).
Area Of Science
- Pediatric cardiac surgery
- Critical care medicine
- Hemodynamic monitoring
Background
- Infants undergoing congenital heart surgery face risks of low cardiac output syndrome (LCOS) and acute kidney injury (AKI).
- The vasoactive-inotropic score (VIS) is used to guide cardiovascular support, but peak VIS (VIS-max) may not fully capture hemodynamic status.
- Early postoperative vasoactive requirements can indicate evolving circulatory stress.
Purpose Of The Study
- To evaluate if early VIS kinetics, specifically area under the curve (VIS-AUC₀-₁₂h) and rate of change (VIS-slope₀-₁₂h), predict LCOS and AKI better than VIS-max.
- To compare the predictive performance of VIS kinetics against VIS-max for LCOS and AKI in infants post-congenital heart surgery.
Main Methods
- Retrospective review of 320 infants (<24 months) after congenital heart surgery with cardiopulmonary bypass.
- Calculation of VIS-max, VIS-AUC₀-₁₂h, and VIS-slope₀-₁₂h using vasoactive doses from the first 12 postoperative hours.
- Standardized criteria for LCOS and AKI; predictive performance assessed using multivariable logistic regression and cross-validated AUCs.
Main Results
- LCOS occurred in 31.6% and AKI in 10.3% of infants.
- Infants with LCOS exhibited higher VIS-max, greater VIS-AUC₀-₁₂h, and steeper VIS-slope₀-₁₂h.
- VIS kinetics modestly improved LCOS prediction over VIS-max (AUC 0.760 vs 0.746) with clinical benefit, but showed limited AKI discrimination.
Conclusions
- Early VIS kinetics provide a more comprehensive assessment of circulatory stress than VIS-max alone in infants after congenital heart surgery.
- VIS trends in the early postoperative period can help identify infants at higher risk for LCOS, guiding closer hemodynamic monitoring.
- Additional renal risk markers are needed for predicting AKI, as VIS metrics have limited value for this complication.
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