Vasoactive-ventilation-renal score in predicting outcome postcardiac surgery in children

OBJECTIVE: The objective of this study was to evaluate vasoactive-ventilation-renal (VVR) score to predict outcome postcardiac surgery in children and establish the time at which the score is best to predict outcome. MATERIALS AND METHODS: This prospective cohort included children ≤18 years recovering from cardiac surgery for congenital heart disease. Data were collected from the Intensive Care Unit (ICU) and vasoactive-inotropic score (VIS) and VVR scores calculated at admission, 24 h, and 48 h postoperatively. Outcome of interest was prolonged length of ICU stay (defined as length of stay [LOS] in the upper 25(th) percentile) and ICU mortality. Correlation between the outcome and scores was obtained and receiver operating characteristic (ROC) curves generated. Independent association of the scores with the outcome was also established. RESULTS: One thousand ninety-seven patients were enrolled with a median age of 24 months (range: 2 days–18 years) including 14.6% with single ventricle physiology. Pediatric ICU LOS >89 h was considered prolonged, and mortality was 2.2%. VVR score correlated better with outcome and had greater area under the curve (AUC) for ROC curve than the corresponding VIS at each study time point. The AUC of ROC curve for VVR score was greatest at 48 h for predicting both prolonged LOS (0.87) and mortality (0.92). VVR score at 48 h remains strongly associated with both prolonged LOS (odds ratio [OR] – 1.24; P = 0.000) and mortality (OR – 1.16; P = 0.000). CONCLUSION: VVR score is effective and robust bedside method to predict prolonged LOS and mortality postpediatric cardiac surgery. VVR score at 48 h was the best to predict outcome.