The association of vasoactive-inotropic score and surgical patients’ outcomes: a systematic review and meta-analysis

Abstract

Background: The objective of this study is to conduct a systematic review and meta-analysis examining the relationship between the vasoactive-inotropic score (VIS) and patient outcomes in surgical settings. Methods: Two independent reviewers searched PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, Google Scholar, and CNKI databases from November 2010, when the VIS was first published, to December 2022. Additional studies were identified through hand-searching the reference lists of included studies. Eligible studies were those published in English that evaluated the association between the VIS and short- or long-term patient outcomes in both pediatric and adult surgical patients. Meta-analysis was performed using RevMan Manager version 5.3, and quality assessment followed the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results: A total of 58 studies comprising 29,920 patients were included in the systematic review, 34 of which were eligible for meta-analysis. Early postoperative VIS was found to be associated with prolonged mechanical ventilation (OR 5.20, 95% CI 3.78–7.16), mortality (OR 1.08, 95% CI 1.05–1.12), acute kidney injury (AKI) (OR 1.26, 95% CI 1.13–1.41), poor outcomes (OR 1.02, 95% CI 1.01–1.04), and length of stay (LOS) in the ICU (OR 3.50, 95% CI 2.25–5.44). The optimal cutoff value for the VIS as an outcome predictor varied between studies, ranging from 10 to 30. Conclusion: Elevated early postoperative VIS is associated with various adverse outcomes, including acute kidney injury (AKI), mechanical ventilation duration, mortality, poor outcomes, and length of stay (LOS) in the ICU. Monitoring the VIS upon return to the Intensive Care Unit (ICU) could assist medical teams in risk stratification, targeted interventions, and parent counseling. Systematic review registration: PROSPERO CRD42022359100.