Castillejos SHA, Monares ZE, Pedraza MA, Contreras CAR, Gómez MC, Aguirre SJS, Camarena AG, Franco GJ

Language: Spanish
References: 14
Page: 258-264
PDF size: 206.78 Kb.

ABSTRACT

Introduction: Vasopressors have a fundamental roll in the treatment of septic shock. LVIS (levosimendan vasopressor inotropic score) as a score that integrates the main vasopressors and inotropic drugs may be useful for monitoring and prognosis. It’s been studied in pediatric population, but not validated in adult patients so far.
Material and methods: Retrospective, longitudinal, retrolective study in adults admitted in ICU with septic shock. We looked to investigate if LVIS score is useful to predict mortality and acute kidney injury in ICU, with a follow-up of 30 days.
Results: We included 77 patients, 24 (21.2%) patients died and 41 (53.23%) developed acute kidney injury. LVIS had an AUC of 0.89 with a cut-off of 21.3 (50% sensitivity and 82% of specificity). LVIS score above the cut-off 21.3, had RR 2.09 (CI95% 1.15-3.7, p = 0.003), HR de 3.8 (CI 1.5-9.3, p = 0.003), LR+ 2.81 and LR- 0.61 for mortality. LVIS could not predict AKI (acute kidney).
Conclusions: LVIS score is useful to predict mortality in patients with septic shock, with a cut-off of 21.3. More research is left to be done to validate this score in other forms of shock in adult population.

REFERENCES

1. Singer M, Deutschman CS, Seymur CW, Shankar-Hari M, et al. The third international consensus definitions for sepsis and septic shock. JAMA. 2016;315(8):801-810.

2. Fleischman C, Scherag A, Adhikari NK, Harlog CS, Tsaganos T, et al. Assesment of global incidence and mortality of hospital- treated sepsis. Current estimate and limitations. Am J Resp Crit Care Med. 2016;193(3):259-272.

3. Daviaud F, Grimaldi D, Dechartres A, Charpentier J, et al. Timing and causes of death in septic shock. Ann Intensive Care. 2015;5:16.

4. Beck V, Chateau D, Bryson GL, Pisipati A, et al. Timing of vasopressor initiation and mortality in septic shock: a cohort study. Crit Care. 2014;18(3):R97.

5. Belleti A, Benedetto U, Biondi-Zoccai G, Leggieri C, et al. The effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials. J Crit Care. 2017;37:91-88.

6. Sviri S, Hashoul J, Stav I, van Heerden PV. Does high-dose vasopressor therapy in medical intensive care patients indicate what we already suspect? J Crit Care. 2014;29:157-160.

7. Farkas DT, Rahnemai-Azar AA, Kunhammed SS, Greenbaum A, et al. Realistic survival outcomes after vasopressor use in the intensive care unit. Am J Hosp Palliat Care. 2016;33:871-874.

8. Belletti A, Castro ML, Silvetti S, Greco T, et al. The effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials. Br J Anaesth. 2015;115:656-675.

9. Auchet T, Regnier MA, Girend N, Levy B. Outcome of patients with septic shock and high-dose vasopressor therapy. Ann Intensive Care. 2017;7:43.

10. Brown SM, Lanspa MJ, Jones JP, Kuttler KG, et al. Survival after shock requiring high-dose vasopressor therapy. Chest. 2013;143:664-671.

11. Davidson J, Tong S, Hancock H, Hauck A, et al. Prospective validation of the vasoactive inotropic score and correlation to short term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012;38:1184-1190.

12. Favia I, Vitale V, Ricci Z. The vasoactive –inotropic score and levosimendan: time for LVIS? J Cardiothorac Vasc Anesth. 2013; 27(2):e15-6.

13. McIntosh AM, Suhong T, Deakyne SJ, Davidson JA, et al. Validation of the vasoactive inotropic score in pediatric sepsis. Pediatr Crit Care Med. 2017 Mayo. En imprenta.

14. Gordon AC, Perkins GD, Singer M, Orme RM, et al. Levosimendan for the prevention of acute organ dysfunction in sepsis. N Engl J Med. 2016;375:1638-1648.