Vasoactive inotropic score as a predictor of mortality in neonatal septic shock

Lay Summary Neonatal sepsis is still one of the most important causes of mortality and morbidity in the neonatal period, and it is also a significant public health problem. Researchers have been looking for reliable biomarkers and scoring systems to detect neonatal sepsis and predict outcomes. The vasoactive inotropic score has been validated and found to be useful for predicting mortality in septic shock in adults and children and newborns who underwent cardiac surgeries. However, there are no neonatal sepsis data. In this retrospective study, we showed that a maximal vasoactive inotropic score of 20 or greater is an easy, noninvasive and useful tool to determine the poor outcome. Background Although many improvements in neonatal care have been achieved, mortality rates for sepsis and septic shock in newborns are still high. The vasoactive inotropic score (VIS) was designed and studied to predict mortality in different settings. There are currently no data on the predictive ability of the VIS for mortality in newborn patients with septic shock. Methods Patients with late-onset neonatal sepsis who required inotropes because of fluid-refractory septic shock during the study period were included in the study. Four distinct VIS values were calculated for each septic shock episode after inotropic treatment had begun, that is, at the initiation of inotropic treatment and at 24 and 48 h after inotropic treatment had begun, and the highest VIS (VISmax) at any time after initiation of inotropic agents. Results The 98 episodes studied were divided into two groups according to the outcomes of their sepsis episodes as survivors (n = 39) or nonsurvivors (n = 59). The areas under the curve of the VIS values for the prediction of mortality were the VISmax (0.819, p < 0.001), followed by the VIS48 (0.802, p < 0.001), VIS24 (0.762, p = 0.001) and VIS0 (0.699, p = 0.015). Patients with a VISmax of greater than 20 had significantly higher odds of mortality (p < 0.001, beta = 14.7, 95% confidence interval [4.7-45.9]). Conclusion We found that the VISmax was an easy-to-use and helpful tool for predicting a poor outcome in neonatal sepsis. Physicians should be aware that the prognosis is poor for any newborn with a VIS of 20 or greater at any point after the onset of sepsis.

Automated summary

Neonatal sepsis is a significant cause of mortality and morbidity in newborns, and researchers are searching for biomarkers and scoring systems to predict outcomes. This study found that a maximal vasoactive inotropic score of 20 or greater can be used as a tool to determine poor outcomes.