Abstract Body (Do not enter title and authors here): Background: The Vasoactive-Inotropic Score (VIS) quantifies vasopressor and inotropic use in cardiogenic shock (CS), with higher VIS indicating greater severity and mortality. This study examines VIS changes within 48 hours post-Mechanical Circulatory Support (MCS) implementation and their correlation with mortality.
Methods: We retrospectively analyzed 2,261 CS patients admitted from Jan 1, 2013, to Dec 31, 2023. Primary outcome is the mean change in VIS score at designated time intervals in the 48 hours after receiving MCS or medical treatment alone. A multivariable Cox proportional hazard regression model was used to evaluate the independent relationship between VIS change and in-hospital mortality.
Results: Patients were categorized into the strategy they received in the first 72 hours of shock onset: medical treatment (n=2044) IABP (n=146), Impella (n=33), or ECMO (n=39). A total of 534 patient died within the index hospitalization. A decrease in the change of the mean VIS score was observed at various time intervals within the first 48 hours (Figure 1). The mean change in VIS score incorporates patients who had a decrease, no change or increase in score in the first 48 hours. Therefore, a hazard ratio <1 in a Cox model would indicate that a more negative mean VIS values correlates with lower mortality. A multivariable Cox model assessing for in-patient mortality incorporated the strategies that patients received (medical treatment, IABP, etc.), age, gender, race medical history, left ventricular ejection fraction, serum creatinine, lactate > 4.5 or pH < 7.2. Our model suggests that a decreased need in the vasoactive medication requiring in the first 48hrs is associated with a reduction in mortality (Figure 2).
Conclusion: All device strategies effectively reduce VIS within 48 hours. The change in mean VIS score within the first 48 hours is independently associated with lower mortality, regardless of the strategy patients received, their past medical history or other clinical covariates.