J Cardiothorac Vasc Anesth. 2026 Sep 15:S1053-0770(26)00887-6. doi: 10.1053/j.jvca.2026.09.006. Online ahead of print.
ABSTRACT
OBJECTIVES: To evaluate the associations of admission vasoactive-inotropic score (VIS) and inotropic score (IS) with postoperative mortality and compare their incremental discrimination beyond baseline clinical and surgical risk.
DESIGN: Retrospective single-center cohort study.
SETTING: Pediatric intensive care unit of a tertiary referral center.
PARTICIPANTS: Pediatric patients (<18 years) undergoing congenital heart surgery with cardiopulmonary bypass between January 2020 and September 2022. A total of 1,450 procedures in 1,324 patients were analyzed; 120 patients underwent more than 1 procedure.
INTERVENTIONS: No specific intervention was performed. VIS and IS were calculated from vasoactive and inotropic drug doses at the time of pediatric intensive care unit admission.
MEASUREMENTS AND MAIN RESULTS: Mortality occurred after 107 procedures (7.38%), representing 107 unique patients (8.1% patient-level mortality). Separate patient-clustered generalized estimating equation logistic models were adjusted for age, sex, weight, and STAT mortality category. Both VIS (odds ratio 1.126 per point, 95% confidence interval 1.101-1.151; p < .001) and IS (odds ratio 1.225, 95% confidence interval 1.177-1.274; p < .001) were independently associated with mortality. The baseline model area under the curve was 0.626 and increased to 0.869 with VIS and 0.852 with IS. The difference between the adjusted VIS and IS models was not statistically significant (Δ area under the curve = 0.017; p = .101).
CONCLUSION: Admission VIS and IS were independently associated with postoperative mortality and improved discrimination beyond baseline risk factors. VIS was not statistically superior to IS. Both scores should be interpreted as objective measures of early postoperative cardiovascular support and illness severity rather than standalone predictive tools.
PMID:42850170 | DOI:10.1053/j.jvca.2026.09.006