Vasoactive-Inotropic Score and in-hospital mortality in preterm infants < 34 weeks' gestation with early pulmonary hypertension in the setting of respiratory distress and sepsis.
Higher Vasoactive-Inotropic Scores in the first 24 hours after pulmonary hypertension diagnosis are associated with increased in-hospital mortality in preterm infants, indicating a need for careful monitoring and risk assessment.
Where it sits
this study against the rest of the vip (vasoactive intestinal polypeptide) corpusSummary and findings
This study evaluated the association between the maximum Vasoactive-Inotropic Score (VISmax-24h) and in-hospital mortality in 238 preterm infants less than 34 weeks' gestation diagnosed with early pulmonary hypertension. The findings indicated that higher VISmax-24h was linked to increased mortality risk. Specifically, each 10-unit increase in VISmax-24h correlated with an odds ratio of 1.42 for mortality.
Abstract
<h4>Purpose</h4>The Vasoactive-Inotropic Score (VIS) quantifies cardiovascular pharmacologic support intensity, but its prognostic value in preterm infants <34 weeks' gestation with early pulmonary hypertension (PH) remains unclear. We aimed to evaluate the independent association between VISmax and in-hospital mortality in this population.<h4>Materials and methods</h4>This single-center retrospective cohort study included 238 preterm infants <34 weeks' gestation diagnosed with early PH (≤14 postnatal days) who were hospitalized in the Department of Neonatology at Guangdong Women and Children Hospital between January 2021 and September 2024. We used the maximum Vasoactive-Inotropic Score recorded in the first 24 h after PH diagnosis (VISmax-24h) as the primary exposure. PH subtypes were retrospectively classified per Mani et al. (2024). Logistic regression with sequential models, restricted cubic splines (RCS), time-dependent Cox regression with 24h/48h landmarks, and Fine-Gray competing risk models were employed.<h4>Results</h4>Of 238 infants, 55 (23.1%) died. VISmax-24h was higher in non-survivors (median 30.0, IQR 7.5-53.5) versus survivors (median 10.0, IQR 0.0-20.0; <i>p</i> < 0.001). The RCS showed a linear dose-response relationship in mortality risk (P for overall association < 0.001; P for non-linearity = 0.142). After adjustment, each 10-unit increase in VISmax-24h was associated with OR 1.42 (95% CI 1.21-1.66; <i>p</i> < 0.001). T3 ≥ 20 versus T1 < 10 conferred adjusted OR 5.40 (95% CI 2.19-13.29; <i>p</i> < 0.001). Time-dependent Cox analysis confirmed persistent post-landmark associations (24h landmark: T3 vs T1 adjusted HR 2.43, 95% CI 1.13-5.19, <i>p</i> = 0.022). In competing risk analysis, high VIS was associated with a significantly higher hazard of severe IVH/PVL (sHR 4.67, <i>p</i> < 0.001), while the association with BPD was confounded by early death.<h4>Conclusions</h4>VISmax-24h is associated with in-hospital mortality in preterm infants with early PH. VISmax-24h ≥20 identifies a high risk phenotype in preterm infants with early PH and may facilitate early risk stratification and family counseling.
Background
The study addresses the prognostic value of the Vasoactive-Inotropic Score (VIS) in preterm infants with early pulmonary hypertension (PH). Prior research has indicated that VIS can quantify pharmacologic support but its specific implications for mortality in this population remain unclear. Understanding this relationship is crucial for risk stratification and management in vulnerable neonates.
Methods
This was a single-center retrospective cohort study involving 238 preterm infants less than 34 weeks' gestation diagnosed with early PH within 14 postnatal days. The primary exposure was the maximum Vasoactive-Inotropic Score recorded in the first 24 hours after PH diagnosis (VISmax-24h). Logistic regression, restricted cubic splines, time-dependent Cox regression, and Fine-Gray competing risk models were utilized for analysis.
Results
Of the 238 infants, 55 (23.1%) died. The median VISmax-24h was significantly higher in non-survivors at 30.0 (IQR 7.5-53.5) compared to survivors at 10.0 (IQR 0.0-20.0; p<0.001). The analysis indicated that each 10-unit increase in VISmax-24h was associated with an odds ratio of 1.42 (95% CI 1.21-1.66; p<0.001), suggesting a strong association with mortality risk.
Interpretation
The findings suggest that higher VISmax-24h is significantly associated with increased mortality in preterm infants with early PH, aligning with previous literature on the prognostic value of VIS. However, the clinical significance of these findings should be interpreted cautiously, as the effect sizes, while statistically significant, may not translate into clinically meaningful outcomes for individual patients. Confounding factors, such as the retrospective design and potential biases, limit the robustness of the conclusions drawn.
Key findings
- 55 (23.1%) of 238 infants died.
- VISmax-24h was higher in non-survivors (median 30.0, IQR 7.5-53.5) versus survivors (median 10.0, IQR 0.0-20.0; p<0.001).
- Each 10-unit increase in VISmax-24h was associated with OR 1.42 (95% CI 1.21-1.66; p<0.001).
- T3 ≥20 versus T1 <10 conferred adjusted OR 5.40 (95% CI 2.19-13.29; p<0.001).
- Time-dependent Cox analysis showed T3 vs T1 adjusted HR 2.43 (95% CI 1.13-5.19, p=0.022).
- High VIS was associated with a significantly higher hazard of severe IVH/PVL (sHR 4.67, p<0.001).
Limitations
- single-center design limits generalizability
- retrospective analysis may introduce bias
- confounding by early death affecting BPD association
- not all potential confounding variables reported