Vasoactive-ventilation-renal score predicts outcomes after pediatric cardiac surgery

A vasoactive-ventilation-renal score has been prospectively validated in children who had surgery for congenital heart disease, researchers reported.

Perspective from David Goldberg, MD

The score was previously developed to predict outcomes in acyanotic infants after surgery for congenital heart disease. At Cardiology 2015, the 18th Annual Update on Pediatric and Congenital Cardiovascular Disease, researchers reported that the score was validated in a broader population, including older children and those with single-ventricle anatomy or mixing lesions.

The researchers evaluated 92 children younger than 18 years (median age, 0.65 years; range, 3 days-17.9 years) who underwent cardiac surgery, 17 of whom had single-ventricle physiology or residual mixing lesions. They recorded admission, peak and 48-hour lactate, vasoactive-inotrope score and vasoactive-ventilation-renal score. The vasoactive-ventilation-renal score includes ventilation index, vasoactive-inotrope score and creatinine change from baseline, according to the researchers.

The primary outcomes were duration of mechanical ventilation and length of ICU stay. The researchers calculated area under receiver operating curve (AUC) for indices and outcomes and modeled the association between elevated indices and prolonged outcomes.

AUCs and ORs for the 48-hour vasoactive-ventilation-renal score were highest for all outcomes compared with admission and peak measurements (AUC for duration of mechanical ventilation = 0.98; OR = 110; 95% CI, 21-588; AUC for ICU length of stay = 0.919; OR = 26; 95% CI, 7.6-91).

Additionally, AUCs and ORs for the 48-hour vasoactive-ventilation-renal score were greater than the values for the 48-hour vasoactive-inotrope score alone (AUC for duration of mechanical ventilation = 0.903; OR = 31; 95% CI, 7.6-128; AUC for ICU length of stay = 0.833; OR = 10; 95% CI, 3.1-32).

Admission, peak and 48-hour lactate were not significant predictors of the primary outcome measures, according to the researchers.

Kyle G. Miletic

“The benefit of this score is twofold,” said Kyle G. Miletic, BS, a medical student at Wayne State University School of Medicine, Detroit. “No. 1, it is very easy to calculate at the bedside. It doesn’t require any cumbersome calculations like some of the other ICU severity-of-disease indices. Also, it doesn’t rely on any experimental biomarkers or laboratory data that are not routinely collected as part of the usual postoperative course. It also captures patients who may be missed by some of the traditional disease severity indices such as the vasoactive-inotrope score alone.”

Future research will examine if the score can be applied to an even broader set of patients, including adults with congenital heart disease, Miletic said. – by Erik Swain

Reference:

Miletic KG, et al. Abstract 912. Presented at: Cardiology 2015, the 18th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 11-15, 2015; Scottsdale, Ariz.

Disclosure: Miletic reports no relevant financial disclosures.

Perspective

David Goldberg, MD

After pediatric cardiac surgery, patients require a fair amount of support in terms of maintaining their circulation, respiration and BP. Any scoring system that can help to predict how patients are going to do is useful for the practitioners taking care of patients. This is an attempt to look at a snapshot of how patients are doing at a particular point in time and to use that snapshot to help guide practitioners as they provide ongoing care for patients recovering from surgery.

David Goldberg, MD

Attending cardiologist, Children’s Hospital of Philadelphia

Disclosures: Goldberg reports no relevant financial disclosures.