Vasoactive-Inotropic Score Reduction Rate Is Highly Associated With Prognosis for Critically Ill Patients With...

Area of Science:

• Critical Care Medicine
• Cardiology
• Clinical Research

Background:

• Cardiogenic shock (CS) management requires precise titration of inotropes and vasopressors.
• The vasoactive-inotropic score (VIS) quantifies hemodynamic support, but its temporal changes' prognostic value is unclear.
• This study investigates the vasoactive-inotropic score reduction rate (VRR) as a predictor of mortality in CS.

Purpose of the Study:

• To evaluate the association between the vasoactive-inotropic score reduction rate (VRR) and mortality in patients with cardiogenic shock.
• To determine if a decreasing VIS over time is associated with improved survival outcomes in CS.

Main Methods:

• Retrospective analysis of 3170 adult CS patients from MIMIC-IV and eICU databases.
• Calculation of VIS using VIS 2020 and definition of VRR to assess temporal VIS changes.
• Comparison of mortality outcomes between VIS-decreasing and VIS-increasing groups using log-rank and Cox regression models.

Main Results:

• An increasing VIS over time was consistently associated with higher in-hospital, ICU, and 28-day mortality in the MIMIC-IV cohort (p < 0.001).
• These findings were replicated in the eICU cohort for ICU and in-hospital mortality (p < 0.001).
• The results demonstrate the robustness and generalizability of VRR as a prognostic indicator across different ICUs.

Conclusions:

• A greater reduction in VIS over time in adult CS patients is strongly linked to lower mortality.
• VRR offers a simple, dynamic measure of vasoactive support trajectories.
• VRR may serve as a valuable tool for risk stratification in CS, complementing existing clinical and biochemical markers, pending prospective validation.