Associations Between Early Vasoactive Inotrope Score Trajectories and Clinical Outcomes in Postcardiotomy Cardiogenic...

To hypothesize that vasoactive-inotropic score (VIS) trajectories following cardiac surgery are independently associated with 30-day all-cause mortality after intensive care unit (ICU) admission, with higher VIS trajectories correlating with worse outcomes in terms of mortality and organ dysfunction.

A single-center, retrospective, observational study.

An adult ICU in a tertiary hospital.

A total of 1,654 postcardiotomy cardiogenic shock (PCCS) patients admitted to the surgical ICU between July 2013 and June 2024.

Retrospective collection and analysis of patients' clinical data were conducted.

Hourly VIS values were calculated during the first 72 hours after ICU admission. Latent class mixed modeling identified 4 distinct VIS trajectory classes from 1,654 PCCS patients: low-level transient rise (class 1, 23.6%), high-level peak-and-decline (class 2, 19.2%), high-level rapid decline (class 3, 18.9%), and low-level steady decline (class 4, 38.3%). Multivariable Cox analysis showed that class 2 was independently associated with increased 30-day all-cause mortality after ICU admission compared with class 4 (adjusted hazard ratio 2.67, 95% confidence interval 1.20-5.97), while no significant association was observed for classes 1 and 3. Class 2 also exhibited the most severe organ dysfunction, including the highest incidence and severity of acute kidney injury, elevated liver biomarkers (alanine aminotransferase and total bilirubin), a higher Sequential Organ Failure Assessment score, persistently impaired peripheral perfusion, and delayed lactate normalization. Notably, among patients with similar initial VIS levels, increasing trajectories (classes 2 and 3) were associated with worse outcomes compared with decreasing trajectories (classes 1 and 4).

The initial 72-hour VIS trajectory stratifies patients with PCCS into 4 distinct classes, which correlate with different clinical outcomes. These findings suggest that VIS trajectory may serve as a risk stratification indicator, providing valuable insights into predicting disease progression and individualized therapy for PCCS patients.