Abstract
Inotrope score is a method of quantifying inotropic and vasoactive support. The purpose of this study was to determine which factors are associated with inotrope score after adult heart transplantation, and whether inotrope score is associated with outcomes after heart transplantation. We determined inotrope scores at 24 and 48 hours after heart transplantation in 74 patients, using the following formula: dopamine (dose × 1) + dobutamine (dose × 1) + amrinone (dose × 1) + milrinone (dose × 15) + epinephrine (dose × 100) + norepinephrine (dose × 100) + enoximone (dose × 1) + isoprenaline (dose × 100), with dose in µg/kg/min. Inotrope scores at 24 hours were categorized into tertiles. We evaluated the association of the inotrope score with clinical variables and outcomes after heart transplantation using regression analyses. Mean age at transplantation was 52 ± 12 years and 40.5% of patients were female. Median inotrope score was 23.2 (interquartile range (IQR) 13.9 - 31.7) and 40.4 (IQR 21.9 - 54.6) at 24 and 48 hours, respectively. Inotrope score at both 24 and 48 hours was independently associated with recipient congenital heart disease (β24h = 0.36 and β48h = 0.31, respectively). Log-rank test showed a trend towards higher long-term mortality up to 10 years with a higher inotrope score (p = .07). Patients with higher inotrope scores (third tertile) had an increased risk (odds ratio 10.5, 95% confidence interval (CI): 2.7 - 41.1) of renal replacement therapy (RRT) compared to the first tertile (figure 1). Patients with higher inotrope scores also showed a trend for increased risk (odds ratio 8.0, 95% CI: 0.9 - 72.5; p = 0.06) for mechanical circulatory support (MCS) post-transplantation. A high inotrope score post-heart transplantation was seen in congenital heart disease recipients. Furthermore, it was associated with a higher risk of requiring renal replacement therapy.
Published Version
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