Afterload-related cardiac performance identifies cardiac impairment and associates with outcome in patients with septic shock: a retrospective cohort study

Abstract Background Septic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnosing septic cardiomyopathy (SCM), still needs to be evaluated for its impact on the prognosis for patients with septic shock. Methods In this retrospective study, 100 patients with septic shock undertaken PiCCO monitoring were included. The ability of ACP, cardiac index (CI), and cardiac power index (CPI) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Cox proportional hazards regression analyses were performed to assess the associations of ACP with day-28 mortality. Curve estimation was used to describe the relationship between the hazard ratio (HR) of death and ACP. Results ACP had a strong linear correlation with CI and CPI (P < 0.001). ACP demonstrated significantly greater discrimination for day-28 mortality than CI before adjusted [AUROC 0.723 (95% CI 0.625 to 0.822) vs. 0.580 (95% CI 0.468 to 0.692), P = 0.007] and CPI after adjusted [AUROC 0.693 (95% CI 0.590 to 0.797) vs. 0.448 (0.332 to 0.565), P < 0.001]. Compared with ACP > 68.78%, HR for ACP ≤ 68.78% was 3.55 (1.93 to 6.54) (P < 0.001). When adjusted with age, APACHE-II score, Vasoactive Inotropic Score, Lactate, CRRT, day-1 volume, fibrinogen and total bilirubin as possible confounders, and decrease ACP are still associated with increasing day-28 mortality (P < 0.05). An exponential relationship was observed between ACP12h and HR of day-28 death. Conclusions Our results suggested thatACP could improve mortality predictions when compared to CI and CPI. Decreased ACP was still an independent risk factor for increased day-28 mortality.

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Prognostic Accuracy of the Afterload-related Cardiac Performance for 7-day Mortality Among Critical Ill Patients With Septic Shock

10.21203/rs.3.rs-76639/v1 ◽

2020 ◽

Author(s):

Wei-yan Chen ◽

Li-li Tao ◽

Qi Xu ◽

Xing Wei ◽

Min-sheng Chen

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Characteristic Curve ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Cardiac Performance ◽

Left Ventricular Ejection ◽

Septic Cardiomyopathy ◽

Icu Mortality ◽

Ventricular Ejection Fraction

Abstract BackgroundSeptic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnostic septic cardiomyopathy (SCM), still needs to be evaluated its impact on the prognosis for patients with septic shock. MethodsIn this observational retrospective study, 119 patients with septic shock undertaken PiCCO monitoring were evaluated for the effects of ACP on 7-day mortality, ICU mortality and hospital mortality. The ability of ACP, cardiac index (CI) and left ventricular ejection fraction (LVEF) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to assess the associations of ACP with 7-day mortality. Curve estimation was used to describe the relationship between hazard ratio (HR) of death and ACP.ResultsACP assessed at 12 hours (ACP12h) after septic shock [AUROC 0.86 (95% CI 0.79 to 0.93), P < 0.001] demonstrated significantly greater discrimination for 7-day mortality than CI [AUROC 0.67 (95% CI 0.57 to 0.78), P = 0.001 ] and LVEF [AUROC 0.53 (95% CI 0.43 to 0.64), P = 0.58] (all P < 0.001). Similarly, when adjusted with gender, APACHEII score, VIS and MAP as possible confounders, ACP12h still outperformed both CI12h and LVEF for discrimination of 7-day mortality (both P < 0.001). The superior discriminatory performance of ACP12h over both CI12h and LVEF was further maintained when considering ICU mortality and hospital mortality when considered in isolation or adjusted with the baseline prediction. Compared with normal ACP, HR for slight, moderate and severe impairment were 4.84 (1.96 to 11.96), 12.13 (4.83 to 30.43) and 32.70 (7.76 to 137.86), respectively. After adjustment for risk factor, decrease ACP still associated with increasing 7-day mortality (P = 0.001). Exponential relationship was observed between ACP12h and HR of 7-day death.ConclusionsOur results suggested that ACP may serve as a new tool for diagnosing SCM. In addition, the assessment of ACP at 12 hours after septic shock in ICU significantly improves 7-day mortality, ICU mortality and hospital mortality predictions when compared to CI and LVEF.

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Endocan Levels in Peripheral Blood Predict Outcomes of Acute Respiratory Distress Syndrome

Mediators of Inflammation ◽

10.1155/2014/625180 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 23

Author(s):

Ling Tang ◽

Ying Zhao ◽

Daoxin Wang ◽

Wang Deng ◽

Changyi Li ◽

...

Keyword(s):

Proportional Hazards ◽

Characteristic Curve ◽

White Blood Cells ◽

Prognostic Significance ◽

Cox Proportional Hazards ◽

Clinical Severity ◽

Apache Ii ◽

Apache Ii Score ◽

Roc Curve Analysis ◽

Severity Scores

Purpose.To investigate the prognostic significance of endocan, compared with procalcitonin (PCT), C-reactive protein (CRP),white blood cells (WBC), neutrophils (N), and clinical severity scores in patients with ARDS.Methods.A total of 42 patients with ARDS were initially enrolled, and there were 20 nonsurvivors and 22 survivors based on hospital mortality. Plasma levels of biomarkers were measured and the acute physiology and chronic health evaluation II (APACHE II) was calculated on day 1 after the patient met the defining criteria of ARDS.Results.Endocan levels significantly correlated with the APACHE II score in the ARDS group (r=0.676,P=0.000,n=42). Of 42 individuals with ARDS, 20 were dead, and endocan was significantly higher in nonsurvivors than in survivors (median (IQR) 5.01 (2.98–8.44) versus 3.01 (2.36–4.36) ng/mL,P=0.017). According to the results of the ROC-curve analysis and COX proportional hazards models, endocan can predict mortality of ARDS independently with a hazard ratio of 1.374 (95% CI, 1.150–1.641) and an area of receiver operator characteristic curve (AUROC) of 0.715 (P=0.017). Moreover, endocan can predict the multiple-organ dysfunction of ARDS.Conclusion.Endocan is a promising biomarker to predict the disease severity and mortality in patients with ARDS.

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Proliferation-dominant high-grade astrocytoma: survival benefit associated with extensive resection of FLAIR abnormality region

Journal of Neurosurgery ◽

10.3171/2018.12.jns182775 ◽

2020 ◽

Vol 132 (4) ◽

pp. 998-1005 ◽

Cited By ~ 4

Author(s):

Haihui Jiang ◽

Yong Cui ◽

Xiang Liu ◽

Xiaohui Ren ◽

Mingxiao Li ◽

...

Keyword(s):

Survival Benefit ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Characteristic Curve ◽

Extent Of Resection ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

High Grade ◽

Extensive Resection ◽

High Grade Astrocytoma

OBJECTIVEThe aim of this study was to investigate the relationship between extent of resection (EOR) and survival in terms of clinical, molecular, and radiological factors in high-grade astrocytoma (HGA).METHODSClinical and radiological data from 585 cases of molecularly defined HGA were reviewed. In each case, the EOR was evaluated twice: once according to contrast-enhanced T1-weighted images (CE-T1WI) and once according to fluid attenuated inversion recovery (FLAIR) images. The ratio of the volume of the region of abnormality in CE-T1WI to that in FLAIR images (VFLAIR/VCE-T1WI) was calculated and a receiver operating characteristic curve was used to determine the optimal cutoff value for that ratio. Univariate and multivariate analyses were performed to identify the prognostic value of each factor.RESULTSBoth the EOR evaluated from CE-T1WI and the EOR evaluated from FLAIR could divide the whole cohort into 4 subgroups with different survival outcomes (p < 0.001). Cases were stratified into 2 subtypes based on VFLAIR/VCE-T1WIwith a cutoff of 10: a proliferation-dominant subtype and a diffusion-dominant subtype. Kaplan-Meier analysis showed a significant survival advantage for the proliferation-dominant subtype (p < 0.0001). The prognostic implication has been further confirmed in the Cox proportional hazards model (HR 1.105, 95% CI 1.078–1.134, p < 0.0001). The survival of patients with proliferation-dominant HGA was significantly prolonged in association with extensive resection of the FLAIR abnormality region beyond contrast-enhancing tumor (p = 0.03), while no survival benefit was observed in association with the extensive resection in the diffusion-dominant subtype (p=0.86).CONCLUSIONSVFLAIR/VCE-T1WIis an important classifier that could divide the HGA into 2 subtypes with distinct invasive features. Patients with proliferation-dominant HGA can benefit from extensive resection of the FLAIR abnormality region, which provides the theoretical basis for a personalized resection strategy.

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Individualized Prediction of Survival Benefits of Pancreatectomy Plus Chemotherapy in Patients With Simultaneous Metastatic Pancreatic Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.719253 ◽

2021 ◽

Vol 11 ◽

Author(s):

Duorui Nie ◽

Guihua Lai ◽

Guilin An ◽

Zhuojun Wu ◽

Shujun Lei ◽

...

Keyword(s):

Pancreatic Cancer ◽

Tumor Size ◽

Proportional Hazards ◽

Survival Curve ◽

Characteristic Curve ◽

Cox Proportional Hazards ◽

Metastatic Pancreatic Cancer ◽

Calibration Plot ◽

Term Survival ◽

Good Ability

BackgroundMetastatic pancreatic cancer (mPC) is a highly lethal malignancy with poorer survival. However, chemotherapy alone was unable to maintain long‐term survival. This study aimed to evaluate the individualized survival benefits of pancreatectomy plus chemotherapy (PCT) for mPC.MethodsA total of 4546 patients with mPC from 2004 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. The survival curve was calculated using the Kaplan-Meier method and differences in survival curves were tested using log-rank tests. Cox proportional hazards regression analyses were performed to evaluate the prognostic value of involved variables. A new nomogram was constructed to predict overall survival based on independent prognosis factors. The performance of the nomogram was measured by concordance index, calibration plot, and area under the receiver operating characteristic curve.ResultsCompared to pancreatectomy or chemotherapy alone, PCT can significantly improve the prognosis of patients with mPC. In addition, patients with well/moderately differentiated tumors, age ≤66 years, tumor size ≤42 mm, or female patients were more likely to benefit from PCT. Multivariate analysis showed that age at diagnosis, sex, marital status, grade, tumor size, and treatment were independent prognostic factors. The established nomogram has a good ability to distinguish and calibrating.ConclusionPCT can prolong survival in some patients with mPC. Our nomogram can individualize predict OS of pancreatectomy combined with chemotherapy in patients with concurrent mPC.

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D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19

PLoS ONE ◽

10.1371/journal.pone.0256744 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256744

Author(s):

Ayusha Poudel ◽

Yashasa Poudel ◽

Anurag Adhikari ◽

Barun Babu Aryal ◽

Debika Dangol ◽

...

Keyword(s):

Proportional Hazards ◽

Characteristic Curve ◽

Area Under The Curve ◽

Respiratory Illness ◽

Immunofluorescence Assay ◽

Cox Proportional Hazards ◽

Optimal Cutoff ◽

Cutoff Value ◽

Potential Biomarker ◽

D Dimer

Introduction Coronavirus Disease 2019 is a primarily respiratory illness that can cause thrombotic disorders. Elevation of D-dimer is a potential biomarker for poor prognosis in COVID-19, though optimal cutoff value for D-dimer to predict mortality has not yet been established. This study aims to assess the accuracy of admission D-dimer in the prognosis of COVID-19 and to establish the optimal cutoff D-dimer value to predict hospital mortality. Methods Clinical and laboratory parameters and outcomes of confirmed COVID-19 cases admitted to four hospitals in Kathmandu were retrospectively analyzed. Admitted COVID-19 cases with recorded D-dimer and definitive outcomes were included consecutively. D-dimer was measured using immunofluorescence assay and reported in Fibrinogen Equivalent Unit (μg/ml). The receiver operating characteristic curve was used to determine the accuracy of D-dimer in predicting mortality, and to calculate the optimal cutoff value, based on which patients were divided into two groups and predictive value of D-dimer for mortality was measured. Results 182 patients were included in the study out of which 34(18.7%) died during the hospital stay. The mean admission D-dimer among surviving patients was 1.067 μg/ml (±1.705 μg/ml), whereas that among patients who died was 3.208 μg/ml (±2.613 μg/ml). ROC curve for D-dimer and mortality gave an area under the curve of 0.807 (95% CI 0.728–0.886, p<0.001). Optimal cutoff value for D-dimer was 1.5 μg/ml (sensitivity 70.6%, specificity 78.4%). On Cox proportional hazards regression analysis, the unadjusted hazard ratio for high D-dimer was 6.809 (95% CI 3.249–14.268, p<0.001), and 5.862 (95% CI 2.751–12.489, p<0.001) when adjusted for age. Conclusion D-dimer value on admission is an accurate biomarker for predicting mortality in patients with COVID-19. 1.5 μg/ml is the optimal cutoff value of admission D-dimer for predicting mortality in COVID-19 patients.

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Osteoprotegerin is Higher in Sepsis Than in Noninfectious SIRS and Predicts 30-Day Mortality of SIRS Patients in the Intensive Care

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.026559 ◽

2019 ◽

Vol 3 (4) ◽

pp. 559-568 ◽

Cited By ~ 1

Author(s):

Hans Kemperman ◽

Irene T Schrijver ◽

Mark Roest ◽

Jozef Kesecioglu ◽

Wouter W van Solinge ◽

...

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Complex Disease ◽

Proportional Hazards ◽

Vascular System ◽

Cox Proportional Hazards ◽

Admission Data ◽

Increased Risk ◽

Severity Of The Disease ◽

Sepsis And Septic Shock

AbstractBackgroundSystemic inflammatory response syndrome (SIRS) is a complex disease involving multiple pathways and organs. Biomarkers reflecting these pathways and organ function could correlate with the severity of the disease. Osteoprotegerin (OPG), mainly known for its role in bone metabolism, is also involved in the immune and vascular system and is therefore an interesting biomarker to study in SIRS patients. In this prospective observational study, we investigated the correlation of plasma OPG concentrations, sepsis, and 30-day mortality of SIRS patients in the intensive care unit (ICU).MethodsThis observational, single-center, cohort study included 313 consecutive patients admitted to the ICU, with an anticipated stay of more than 48 h and SIRS on admission. Data from included patients were collected daily until discharge or death for a maximum of 10 days. Thirty-day mortality was retrospectively assessed. OPG concentrations were measured in the first 48 h after admission. The relation of OPG with no sepsis, sepsis, and septic shock was assessed with the Kruskal–Wallis test and the Mann–Whitney U-test. Cox proportional hazards regression was used to study OPG concentrations and 30-day mortality.ResultsOPG concentrations were higher in patients with sepsis and septic shock than in patients without sepsis. Furthermore, patients with OPG concentrations in the highest tertile at admission in the ICU have an increased risk of mortality within 30 days when compared to patients with OPG concentrations in the lowest and middle tertiles, independent of acute physiologic and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) scores.ConclusionsWe show that OPG is a biomarker that correlates with sepsis and predicts mortality of SIRS patients in the ICU.

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The Risk of Seizure Following Surgery for Brain Arteriovenous Malformation: A Prospective Cohort Study

Neurosurgery ◽

10.1093/neuros/nyx101 ◽

2017 ◽

Vol 81 (6) ◽

pp. 935-948 ◽

Cited By ~ 2

Author(s):

Joan Margaret O’Donnell ◽

Michael Kerin Morgan ◽

Gillian Z Heller

Keyword(s):

Confidence Interval ◽

Proportional Hazards ◽

Cox Regression ◽

Characteristic Curve ◽

Continuous Variable ◽

Receiver Operator Characteristic Curve ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Maximum Diameter ◽

Discharge From Hospital

Abstract BACKGROUND The evidence for the risk of seizures following surgery for brain arteriovenous malformations (bAVM) is limited. OBJECTIVE To determine the risk of seizures after discharge from surgery for supratentorial bAVM. METHODS A prospectively collected cohort database of 559 supratentorial bAVM patients (excluding patients where surgery was not performed with the primary intention of treating the bAVM) was analyzed. Cox proportional hazards regression models (Cox regression) were generated assessing risk factors, a Receiver Operator Characteristic curve was generated to identify a cut-point for size and Kaplan–Meier life table curves created to identify the cumulative freedom from postoperative seizure. RESULTS Preoperative histories of more than 2 seizures and increasing maximum diameter (size, cm) of bAVM were found to be significantly (P < .01) associated with the development of postoperative seizures and remained significant in the Cox regression (size as continuous variable: P = .01; hazard ratio: 1.2; 95% confidence interval: 1.0-1.3; more than 2 seizures: P = .02; hazard ratio: 2.1; 95% confidence interval: 1.1-3.8). The cumulative risk of first seizure after discharge from hospital following resection surgery for all patients with bAVM was 5.8% and 18% at 12 mo and 7 yr, respectively. The 7-yr risk of developing postoperative seizures ranged from 11% for patients with bAVM ≤4 cm and with 0 to 2 preoperative seizures, to 59% for patients with bAVM >4 cm and with >2 preoperative. CONCLUSION The risk of seizures after discharge from hospital following surgery for bAVM increases with the maximum diameter of the bAVM and a patient history of more than 2 preoperative seizures.

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Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03750-14 ◽

2014 ◽

Vol 58 (12) ◽

pp. 7468-7474 ◽

Cited By ~ 26

Author(s):

W. Picard ◽

F. Bazin ◽

B. Clouzeau ◽

H.-N. Bui ◽

M. Soulat ◽

...

Keyword(s):

Septic Shock ◽

Renal Failure ◽

Regression Analysis ◽

Severe Sepsis ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Adjusted Relative Risk ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Increased Risk

ABSTRACTTo assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ± 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk = 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.

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A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study

Disease Markers ◽

10.1155/2021/5598824 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Kang Li ◽

Chi Zhang ◽

Ling Qin ◽

Chaoran Zang ◽

Ang Li ◽

...

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Characteristic Curve ◽

Length Of Hospital Stay ◽

Cox Proportional Hazards ◽

Brier Score ◽

Rank Test

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You’An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan–Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10–18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 ( 95 % confidence interval CI = 0.69 – 0.83 ), and the AUC was 0.88 ( 95 % CI = 0.82 – 0.95 ). The adjusted C-index was 0.75 ( 95 % CI = 0.67 – 0.82 ) and adjusted AUC 0.86 ( 95 % CI = 0.73 – 0.95 ), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 ( 95 % CI = 0.07 – 0.15 ) and adjusted Brier score of 0.130 ( 95 % CI = 0.07 – 0.20 ) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 ( 95 % CI = 0.69 – 0.89 ), 0.89 ( 95 % CI = 0.83 – 0.96 ), and 0.96 ( 95 % CI = 0.92 – 1.00 ), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.

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Vascular Reactivity Index as an Effective Predictor of Mortality in Children With Refractory Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066620914850 ◽

2020 ◽

pp. 088506662091485 ◽

Cited By ~ 2

Author(s):

En-Pei Lee ◽

Lu-Lu Zhao ◽

Shao-Hsuan Hsia ◽

Oi-Wa Chan ◽

Chia-Ying Lin ◽

...

Keyword(s):

Septic Shock ◽

Vascular Reactivity ◽

Characteristic Curve ◽

Pediatric Intensive Care ◽

Reactivity Index ◽

Survival Group ◽

Risk Of Mortality ◽

Inotropic Score ◽

Refractory Septic Shock ◽

Vasoactive Inotropic Score

Background: Vasoplegia is vascular hyporesponsiveness to vasopressors and is an important phenomenon in children with refractory septic shock. This study aimed to develop an objective formula correlated with vasoplegia and evaluate the predictive power for mortality in children with refractory septic shock. Materials and Methods: We retrospectively analyzed children with refractory septic shock admitted to a pediatric intensive care unit (PICU) and monitored their hemodynamics via a pulse index continuous cardiac output (PiCCO) system. Serial hemodynamic data including cardiac index (CI), systemic vascular resistant index (SVRI) and vasoactive-inotropic score (VIS) were recorded during the first 72 hours after PICU admission. We defined vascular reactivity index (VRI) as SVRI/VIS and analyzed the effect of VRI in predicting mortality in children with refractory septic shock. Results: Thirty-three children with refractory septic shock were enrolled. The SVRI was lower in the mortality group compared to the survival group ( P < .05). The average area under the receiver operating characteristic curve of VRI within the first 72 hours was 0.8 and the serial values of VRI were significantly lower in the mortality group during the period from 0 to 48 hours ( P < .05). However, there were no significant differences in serial CI values between the survival and mortality groups. Conclusions: Vasoactive-inotropic score may potentially be used to quantify the severity of vasoplegia based on the clinical response of vessels after resuscitation with vasopressors. Lower VRI levels may indicate a higher risk of mortality in children with septic shock.

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