Vasoactive–Inotropic Score Reduction Rate Is Highly Associated With Prognosis for Critically Ill Patients With Cardiogenic Shock: Insights From the Real-World Dynamic Data

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Therapeutics Pub Date : 2026-03-06 DOI:10.1155/cdr/8989505

Yi-Le Ning, Tian-Xiang Guan, Xiao-Li Niu, Qian-Qian Ma, Yuan-Na Zhang, Ting-Yu Peng, Li-Xiong Zeng, Hang Li, Hui-Ting Guan

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Abstract

Background

In cardiogenic shock (CS), titration of both the choice and dosage of inotropes and vasopressors is crucial. The vasoactive–inotropic score (VIS) quantifies hemodynamic support, while the effect of temporal VIS change on prognosis remains unclear. This study evaluated the association between the vasoactive–inotropic score reduction rate (VRR) to measure VIS changes over time and explore its association with mortality in CS patients.

Methods

We performed a retrospective observational study using two large intensive care databases (MIMIC-IV and eICU). Adult patients with CS receiving vasoactive–inotropic agents within 24 h after ICU admission were included. VIS was calculated using the updated VIS 2020, and VRR was defined to capture the relative change in VIS over time. Patients were categorized into VIS-decreasing and VIS-increasing groups. The primary outcome was in-hospital mortality; secondary outcomes were intensive care unit (ICU) and 28-day mortality (28-day mortality only for the MIMIC-IV database). Associations between VRR and outcomes were examined using four models: (1) log-rank analysis, (2) Cox model adjusted for all covariates, (3) Cox model adjusted for covariates selected by univariable analyses, and (4) Cox model adjusted for covariates selected by a random forest algorithm.

Results

A total of 3170 adult CS patients were analyzed. All models in both MIMIC-IV and eICU showed that an increasing VIS over time was consistently associated with higher in-hospital, ICU, and 28-day mortality compared with a decreasing VIS in the MIMIC-IV cohort (p < 0.001). These findings were reproduced in the external eICU cohort for ICU and in-hospital mortality (p < 0.001), supporting the robustness and generalizability of VRR as a prognostic indicator across heterogeneous ICUs.

Conclusions

In adult CS patients, a greater reduction in VIS over time is strongly associated with lower mortality. VRR provides a simple, dynamic summary of vasoactive trajectories and may serve as a useful adjunct for risk stratification alongside other clinical and biochemical markers, although prospective validation is warranted.

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血管活性-肌力评分降低率与心源性休克危重患者的预后高度相关：来自真实世界动态数据的见解

背景：在心源性休克（CS）中，收缩性药物和血管加压药物的选择和剂量的滴定是至关重要的。血管活性-肌力评分（vasoactive-inotropic score， VIS）量化血流动力学支持，而颞叶VIS变化对预后的影响尚不清楚。本研究评估了用于测量VIS随时间变化的血管活性-肌力评分降低率（VRR）之间的关系，并探讨其与CS患者死亡率的关系。方法：我们使用两个大型重症监护数据库（MIMIC-IV和eICU）进行回顾性观察研究。纳入ICU入院后24小时内接受血管活性肌力药物治疗的成年CS患者。VIS使用更新后的VIS 2020计算，VRR定义为捕捉VIS随时间的相对变化。将患者分为vis降低组和vis升高组。主要结局是住院死亡率；次要结局是重症监护病房（ICU）和28天死亡率（仅MIMIC-IV数据库的28天死亡率）。采用四种模型检验VRR与结局的相关性：(1)log-rank分析，(2)Cox模型对所有协变量进行校正，(3)Cox模型对单变量分析选择的协变量进行校正，(4)Cox模型对随机森林算法选择的协变量进行校正。结果：共分析3170例成人CS患者。MIMIC-IV和eICU的所有模型均显示，随着时间的推移，与MIMIC-IV队列中VIS降低相比，VIS增加始终与住院、ICU和28天死亡率升高相关（p < 0.001）。这些发现在外部eICU的ICU和住院死亡率队列中得到了重复（p < 0.001），支持VRR作为异质ICU预后指标的稳健性和普遍性。结论：在成年CS患者中，随着时间的推移，VIS的大幅度降低与较低的死亡率密切相关。VRR提供了血管活性轨迹的简单、动态总结，可以与其他临床和生化指标一起作为危险分层的有用辅助，尽管需要进行前瞻性验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Therapeutics 医学-心血管系统

CiteScore

5.60

自引率

0.00%

发文量

审稿时长

6 months

期刊介绍： Cardiovascular Therapeutics (formerly Cardiovascular Drug Reviews) is a peer-reviewed, Open Access journal that publishes original research and review articles focusing on cardiovascular and clinical pharmacology, as well as clinical trials of new cardiovascular therapies. Articles on translational research, pharmacogenomics and personalized medicine, device, gene and cell therapies, and pharmacoepidemiology are also encouraged. Subject areas include (but are by no means limited to): Acute coronary syndrome Arrhythmias Atherosclerosis Basic cardiac electrophysiology Cardiac catheterization Cardiac remodeling Coagulation and thrombosis Diabetic cardiovascular disease Heart failure (systolic HF, HFrEF, diastolic HF, HFpEF) Hyperlipidemia Hypertension Ischemic heart disease Vascular biology Ventricular assist devices Molecular cardio-biology Myocardial regeneration Lipoprotein metabolism Radial artery access Percutaneous coronary intervention Transcatheter aortic and mitral valve replacement.