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Original article
Evaluation of the vasoactive-inotropic score, mid-regional pro-adrenomedullin and cardiac troponin I as predictors of low cardiac output syndrome in children after congenital heart disease surgery
Evaluación de la escala vasoactiva-inotrópica, pro-adrenomedulina y troponina cardiaca-I como factores predictivos del síndrome de bajo gasto cardiaco en niños tras corrección quirúrgica de cardiopatías congénitas
J.L. Pérez-Naveroa,b,, , C. Merino-Cejasc, I. Ibarra de la Rosaa,b, S. Jaraba-Caballeroa,b, M. Frias-Pereza,b, E. Gómez-Guzmánd, M. Gil-Camposb, M.J. de la Torre-Aguilarb
a Paediatric Intensive Care Unit at the Department of Paediatrics, Reina Sofia University Hospital, University of Córdoba, Spain
b Paediatric Research Unit at Reina Sofía University Hospital, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Cordoba, Spain
c Pediatric Cardiovascular Surgery Unit, Reina Sofia University Hospital, Spain
d Paediatric Cardiology Unit at the Department of Paediatrics, Reina Sofia University Hospital, Spain
Received 05 October 2017, Accepted 24 April 2018
Abstract
Objective

To determine the predictive value of the inotropic score (IS) and vasoactive-inotropic score (VIS) in low cardiac output syndrome (LCOS) in children after congenital heart disease surgery involving cardiopulmonary bypass (CPB), and to establish whether mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I), associated to the IS and VIS scores, increases the predictive capacity in LCOS.

Design

A prospective observational study was carried out.

Setting

A Paediatric Intensive Care Unit.

Patients

A total of 117children with congenital heart disease underwent CPB. Patients were divided into two groups: LCOS and non-LCOS.

Interventions

The clinical and analytical data were recorded at 2, 12, 24 and 48h post-CPB. Logistic regression was used to develop a risk prediction model using LCOS as dependent variable.

Main outcome measures

LCOS, IS, VIS, MR-proADM, cTn-I, age, sex, CPB time, PIM-2, Aristotle score.

Results

While statistical significance was not recorded for IS in the multivariate analysis, VIS was seen to be independently associated to LCOS. On the other hand, VIS>15.5 at 2h post-CPB, adjusted for age and CPB timepoints, showed high specificity (92.87%; 95%CI: 86.75–98.96) and increased negative predictive value (75.59%, 95%CI: 71.1–88.08) for the diagnosis of LCOS at 48h post-CPB. The predictive power for LCOS did not increase when VIS was combined with cTn-I >14ng/ml at 2h and MR-proADM >1.5nmol/l at 24h post-CPB.

Conclusions

The VIS score at 2h post-CPB was identified as an independent early predictor of LCOS. This predictive value was not increased when associated with LCOS cardiac biomarkers. The VIS score was more useful than IS post-CPB in making early therapeutic decisions in clinical practice post-CPB.

Resumen
Objetivo

Estudiar el valor predictivo de la escala inotrópica (IS) y la escala vasoactiva-inotrópica (VIS) en el síndrome de bajo gasto cardiaco (SBGC) en niños poscirugía de cardiopatías congénitas mediante bypass cardiopulmonar (BCP). Determinar si adrenomedulina (MR-proADM) y troponina cardiaca-I (cTn-I) asociadas con IS y VIS incrementan su capacidad predictora de SBGC.

Diseño

Estudio prospectivo y observacional.

Ámbito

Cuidados intensivos pediátricos.

Pacientes

Ciento diecisiete pacientes pediátricos con cardiopatías congénitas corregidos mediante BCP, clasificados en función de la presencia o no de SBGC.

Intervenciones

Los datos analíticos y clínicos se midieron a las 2, 12, 24 y 48h post-BCP. Las principales variables se analizaron mediante regresión logística multivariante, considerando SBGC como variable dependiente.

Variables de interés principales

SBGC, IS, VIS, MR-proADM, cTn-I, edad, sexo, BCP, PIM-2 y escala Aristóteles.

Resultados

El IS no alcanzó significación estadística en el estudio multivariante; sin embargo, el VIS se asoció independientemente a SBGC. El VIS>15,5 a las 2h del ingreso en CIP, ajustado por edad y tiempo de CEC, muestra alta especificidad (92,87%; IC 95%: 86,75-98,96%) y alto valor predictivo negativo (75,59%; IC 95%: 71,10-88,08) para predecir SBGC a las 48h post-BCP. La capacidad predictora no se incrementa al incorporar cTn-I>14ng/ml a las 2h y ADM>1,5nmol/l a las 24h del postoperatorio.

Conclusiones

El VIS a las 2h post-BCP es un predictor independiente precoz de SBGC. Este valor no se incrementa al asociarse biomarcadores cardiacos de LCOS. La escala de VIS fue más útil que la escala de IS en la toma de decisiones terapéuticas tras la cirugía cardiaca.

Keywords
Cardiac biomarkers, Congenital heart disease, Inotropic score, Vasoactive inotropic score
Palabras clave
Biomarcadores cardiacos, Cardiopatías congénitas, Escala inotrópica, Escala vasoactiva-inotrópica

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