Development and performance of a novel vasopressor-driven mortality prediction model in septic shock

Abstract

BackgroundVasoactive medications are essential in septic shock, but are not fully incorporated into current mortality prediction risk scores. We sought to develop a novel mortality prediction model for septic shock incorporating quantitative vasoactive medication usage.MethodsQuantitative vasopressor use was calculated in a cohort of 5352 septic shock patients and compared using norepinephrine equivalents (NEE), cumulative vasopressor index and the vasoactive inotrope score models. Having best discrimination prediction, log10NEE was selected for further development of a novel prediction model for 28-day and 1-year mortality via backward stepwise logistic regression. This model termed ‘MAVIC’ (Mechanical ventilation, Acute Physiology And Chronic Health Evaluation-III, Vasopressors, Inotropes, Charlson comorbidity index) was then compared to Acute Physiology And Chronic Health Evaluation-III (APACHE-III) and Sequential Organ Failure Assessment (SOFA) scores in an independent validation cohort for its accuracy in predicting 28-day and 1-year mortality.Measurements and main resultsThe MAVIC model was superior to the APACHE-III and SOFA scores in its ability to predict 28-day mortality (area under receiver operating characteristic curve [AUROC] 0.73 vs. 0.66 and 0.60) and 1-year mortality (AUROC 0.74 vs. 0.66 and 0.60), respectively.ConclusionsThe incorporation of quantitative vasopressor usage into a novel ‘MAVIC’ model results in superior 28-day and 1-year mortality risk prediction in a large cohort of patients with septic shock.

SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative

“…Patients were classified retrospectively and not prospectively, as was the intention of the SCAI writing group. In addition, standardized scoring methods for vasopressor requirements, such as described by Vallabhajosyula et al, 12 were not utilized as data on doses of medications were insufficient to report such measures. Finally, hemodynamic data were only available to 24 hr after the index PCI, so changes in shock stage beyond that point were not captured but may have influenced survival to discharge.…”

Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature

“…Acute myocardial infarction (AMI) with consequent left ventricular (LV) dysfunction remains the most common etiology and comprises nearly 80% of all CS [1–5]. Less frequently, CS is seen as a complication of post-cardiotomy status, end-stage heart failure, Takotsubo cardiomyopathy, acute pulmonary embolism, acute myocarditis, and septic cardiomyopathy [6–14]. Historically, CS patients were managed with the use of high-dose vasopressors/inotropes and the use of intra-aortic balloon pump (IABP) for mechanical circulatory support (MCS) [15].…”

Natriuretic Peptides to Predict Short-Term Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis

“…2,3 Cardiac dysfunction in patients with sepsis can manifest as a combination of circulatory failure, septic cardiomyopathy, and myocardial injury and refractory shock. 1,[4][5][6][7][8][9][10][11][12][13] With the development of sensitive laboratory technology, there is a renewed interest in the use of biomarkers for early and targeted treatment of cardiac dysfunction in patients with sepsis and septic shock. 1 Cardiac biomarkers, such as cardiac troponin T, troponin I, B-type natriuretic peptide (BNP), and N-terminal pro-BNP (NT-proBNP), have been studied previously in patients with sepsis and septic shock.…”