Association between vasoactive–inotropic score, morbidity and mortality after heart transplantation. Issue 4 (17th April 2023) - Tohme, Joanna
Abstract : Despite major advances in durable mechanical circulatory support (MCS), heart transplantation (HTx) remains the most valuable therapeutic option for patients with end-stage heart failure [1, 2]. Abstract: OBJECTIVES: The aim of this study was to evaluate the association between vasoactive–inotropic score (VIS), calculated in the 24 h after heart transplantation, and post-transplant mortality and morbidity. METHODS: This was an observational single-centre retrospective study. Patients admitted to surgical intensive care unit after transplantation, between January 2015 and December 2018, were reviewed consecutively. VISmax was calculated as dopamine+ dobutamine+ 100 × epinephrine + 100 × norepinephrine + 50 × levosimendan + 10 × milrinone (all in µg/kg/min) + 10 000 × vasopressin (units/kg/min), using the maximum dosing rates of vasoactive and inotropic medications in the 24 h after intensive care unit admission. The primary outcome was mortality at 1 year post-transplant. The secondary outcomes included length of stay, duration of mechanical ventilation and inotropic support and the occurrence of septic shock, ventilator-associated pneumonia, bloodstream infection or renal replacement therapy. RESULTS: A total of 151 patients underwent heart transplantation and admitted to intensive care unit. The median VISmax was 39.2 (interquartile range = 19.4–83.0). VISmax was independently associated with 1-year post-transplant mortality, as well as recipient age [hazard ratio (HR) = 1.004, P -value = 0.013], recipient gender (female to male: hazard ratio = 2.23, P -value = 0.047) and combined transplantation (hazard ratio = 2.85, P -value = 0.048). There was a significant association between VISmax and duration of mechanical ventilation ( P -value < 0.001), length of stay ( P -value = 0.002), duration of infused inotropes ( P -value < 0.001), occurrence of bloodstream infections, septic shocks, ventilation-acquired pneumonia and renal replacement therapy. CONCLUSIONS: VISmax calculated during the first 24 h after postoperative intensive care unit admission in transplanted patients is independently associated with 1-year mortality. In addition, length of stay, duration of mechanical ventilation and infused inotropes increased with increasing VISmax .