Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care

Background: The cardiovascular component of the sequential organ failure assessment (cvSOFA) score may be outdated because of changes in intensive care. Vasoactive Inotropic Score (VIS) represents the weighted sum of vasoactive and inotropic drugs. We investigated the association of VIS with mortality in the general intensive care unit (ICU) population and studied whether replacing cvSOFA with a VIS-based score improves the accuracy of the SOFA score as a predictor of mortality.

Methods: We studied the association of VIS during the first 24 h after ICU admission with 30-day mortality in a retrospective study on adult medical and non-cardiac emergency surgical patients admitted to Kuopio University Hospital ICU, Finland, in 2013-2019. We determined the area under the receiver operating characteristic curve (AUROC) for the original SOFA and for SOFA_VISmax , where cvSOFA was replaced with maximum VIS (VIS_max ) categories.

Results: Of 8079 patients, 1107 (13%) died within 30 days. Mortality increased with increasing VIS_max . AUROC was 0.813 (95% confidence interval [CI], 0.800-0.825) for original SOFA and 0.822 (95% CI: 0.810-0.834) for SOFA_VISmax , p < .001.

Conclusion: Mortality increased consistently with increasing VIS_max . Replacing cvSOFA with VIS_max improved the predictive accuracy of the SOFA score.