The early predictive value of vasoactive inotropic score in persistent pulmonary hypertension of the newborn / 中国新生儿科杂志

ABSTRACT

Objective:To study the early predictive value of vasoactive inotropic score (VIS) for mortality in persistent pulmonary hypertension of the newborn (PPHN).Method:From July 2017 to November 2020, clinical data of infants diagnosed with PPHN (gestational age ≥34 weeks and admission age <7 days) admitted to our department of neonatology were retrospectively analyzed. According to their clinical outcome, the infants were assigned into survival group and death group. Demographics, risk factors of mortality and the series of VIS within 12 hours after admission were collected. These indicators were compared between the two groups to determine the confounding factors of mortality. Logistic regression was used to determine the correlation between VIS and mortality. The predictive value of VIS for the mortality of infants with PPHN was calculated using ROC curve.Result:A total of 105 infants with PPHN were enrolled, including 75 in survival group and 30 in death group. The overall mortality rate was 28.6% (30/105). Compared with survival group, the death group had higher gestational age [(39.1±1.8) weeks vs. (37.9±2.0) weeks], lower Apgar score at 1 minute [8.0 (6.0, 9.3) vs. 9.0 (8.0, 10.0)] and lower PaO 2/FiO 2 within 12 hours after admission [40 (30, 50) vs. 80 (60, 100)]. After adjusting for gestational age, Apgar score at 1min and lowest PaO 2/FiO 2 within 12 hours after admission, the maximal VIS (VISmax) >27.8 within 12 hours after admission was independently correlated with increased risk of mortality ( OR=23.055, 95% CI 4.885~108.800, P<0.001). ROC curve analysis showed that the cut-off value was 27.8, with 70.0% sensitivity and 90.7% specificity predicting mortality (AUC=0.828, Youden index=0.607). Conclusion:VIS could be used as an early predictor of mortality in PPHN. The infants with VISmax greater than 27.8 within 12 hours after admission have increased risk of mortality.