The predictive value of the vasoactive inotropic score in the postoperative treatment of patients suffering from infective endocarditis

Abstract

Abstract The study aimed to analyze the predictive value of the vasoactive inotropic score (VIS) in the postoperative treatment of patients undergoing valve surgery for infective endocarditis (IE). At our institution, 334 patients underwent valve surgery for IE from 01/2016 to 12/2022. Patients with postoperative MCS device were excluded from this study. Data are presented as medians and 25th – 75th percentiles, or absolute numbers and percentages. Non-survivors had a significantly higher EuroSCORE II preoperatively (4.5 (2.3–9.8)% vs. 12.6 (5.7–20.9)%, p  < 0.001). In non-survivors, Staphylococcus (89 (32.1%) vs. 20 (54.1%), p  = 0.01) and Staphylococcus aureus (62 (22.4%) vs. 14(37.8%), p  = 0.064) were significantly more frequently identified as causative pathogens. Non-survivors had significantly higher IL-6 levels at POD 1, 2 and 4 compared to survivors ( p  < 0.021). Non survivor had significantly higher VIS immediately postoperatively as well as 6 h, 12 h, 24 h, 36 h and 48 h after surgery. In addition, VIS at 48 h was identified as an independent variable associated with non-survival at values > 4.1. When comparing the ROC of lactate, ScvO2 and VIS after 48 h, VIS showed the highest AUC. The VIS is particularly suitable for patients with infective endocarditis due to combined assessment of postoperative cardiovascular dysfunction and IE related inflammatory response. We provided suggestive evidence that the amount of cardiovascular support represented as the VIS has a predictive value regarding mortality in patients undergoing valve replacement for IE. In addition, VIS showed superiority compared to conventional scoring systems for predicting outcome in the intensive care of postoperative IE patients.