Combining vasoactive-inotropic score with lactate to predict mortality in post-cardiotomy patients supported with venoarterial extracorporeal membrane oxygenation.

Abstract

To determine the predictive role of combined assessment of vasoactive-inotropic score and lactate for the prognosis of patients with postcardiotomy cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. The data of adult patients with postcardiotomy cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation between January 2015 and December 2018 at a tertiary hospital was retrospectively analyzed. The incidence of in-hospital mortality and other clinical outcomes were analyzed. The associations of vasoactive-inotropic score and lactate and in-hospital mortality were assessed using logistic regression analysis. 222 patients were included and divided into four groups according to the cut-off points of vasoactive-inotropic score (24.3) and lactate level (6.85 mmol/L). The in-hospital mortality rates were 37.7%, 50.7%, 54.8% and 76.5% for the four groups (P < 0.001), while the rates of successful weaning off extracorporeal membrane oxygenation were 73.9%, 69%, 61.3% and 39.2% respectively (P = 0.001). The group 1 and group 2 exhibited significant differences compared to group 4 in both in-hospital mortality and weaning rates (P < 0.05). There was a statistically significant difference in the incidence of multiple organ dysfunction between group 1 and group 4 (P < 0.05). Groups 1, 2 and 3 demonstrated significantly improved cumulative 30-day survival compared with group 4 (log-rank test, P < 0.05). Logistic regression analysis revealed that age, vasoactive-inotropic score > 24.3 and lactate > 6.85 mmol/L were independently predictive of in-hospital mortality. Among patients with postcardiotomy cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation, the initiation before reaching vasoactive-inotropic score > 24.3 and lactate > 6.85 mmol/L was associated with improved in-hospital outcomes, suggesting that combined assessment of VIS and lactate may be instructive for determining the initiation of venoarterial extracorporeal membrane oxygenation.