Association between preoperative vasoactive inotropic score and clinical outcomes in severe pneumonia patients with sepsis undergoing extracorporeal membrane oxygenation: an analysis from the Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry.

backgroundExtracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with severe respiratory and/or cardiac failure. In patients with severe pneumonia, severe septic shock led to the need for vasopressor and inotropic drugs to maintain the patients' circulatory function. The vasoactive inotropic score (VIS) is calculated as a weighted sum of all administered vasopressor and inotropic medications and quantifies the amount of pharmacological cardiovascular support. This study aimed to evaluate the association between preoperative VIS score and clinical outcomes among adult severe pneumonia patients with sepsis undergoing ECMO support.

methodsAdult patients diagnosed with severe pneumonia complicated with sepsis from January 2013 to June 2022 were obtained from the Chinese Society of Extracorporeal Life Support (CSECLS) registry database. The study endpoints included in-hospital mortality and failure of weaning for ECMO. Restricted cubic spline (RCS) was used to explore the association between VIS and the risk of adverse clinical outcomes. A backward stepwise logistic multivariable regression was used for assessing influence factors of study endpoints. Unadjusted and adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to identify the association.

resultsAmong 825 enrolled patients, there were 386 cases of in-hospital mortality and 241 cases of ECMO weaning failure. Patients in the in-hospital death group were older, had a higher SOFA score, lower mean arterial pressure, and higher VIS. A linear relationship existed between VIS and the risk of in-hospital death as well as the risk of failed weaning from ECMO support. Regardless of whether patients received VV-ECMO assistance or VA-ECMO support, as the VIS level increased, both the risk of in-hospital mortality and the risk of ECMO weaning failure also increased linearly. In the further subgroup analysis, the results were found to be robust.

conclusionLinear correlation existed between VIS score and the risk of in-hospital death as well as the risk of ECMO weaning failure in adult patients with severe pneumonia combined with sepsis. With the increase of VIS score, the risk of in-hospital death and ECMO weaning failure also increased. VIS may be a useful practical tool for risk stratification of adverse clinical outcomes.