# The predictive value of the vasoactive inotropic score in the postoperative treatment of patients suffering from infective endocarditis

## TL;DR

This study shows that the vasoactive inotropic score (VIS) can predict mortality in patients with infective endocarditis after valve surgery, outperforming conventional scoring systems.

## Contribution

The VIS is shown to be a superior predictor of mortality in postoperative infective endocarditis patients compared to traditional metrics.

## Key findings

- Non-survivors had significantly higher VIS values immediately postoperatively and up to 48 hours later.
- VIS at 48 hours with values >4.1 was independently associated with non-survival.
- VIS outperformed lactate and ScvO2 in predicting outcomes with the highest AUC in ROC analysis.

## Abstract

The study aimed to analyze the predictive value of the vasoactive inotropic score (VIS) in the postoperative treatment of patients undergoing valve surgery for infective endocarditis (IE). At our institution, 334 patients underwent valve surgery for IE from 01/2016 to 12/2022. Patients with postoperative MCS device were excluded from this study. Data are presented as medians and 25th – 75th percentiles, or absolute numbers and percentages. Non-survivors had a significantly higher EuroSCORE II preoperatively (4.5 (2.3–9.8)% vs. 12.6 (5.7–20.9)%, p < 0.001). In non-survivors, Staphylococcus (89 (32.1%) vs. 20 (54.1%), p = 0.01) and Staphylococcus aureus (62 (22.4%) vs. 14(37.8%), p = 0.064) were significantly more frequently identified as causative pathogens. Non-survivors had significantly higher IL-6 levels at POD 1, 2 and 4 compared to survivors (p < 0.021). Non survivor had significantly higher VIS immediately postoperatively as well as 6 h, 12 h, 24 h, 36 h and 48 h after surgery. In addition, VIS at 48 h was identified as an independent variable associated with non-survival at values > 4.1. When comparing the ROC of lactate, ScvO2 and VIS after 48 h, VIS showed the highest AUC. The VIS is particularly suitable for patients with infective endocarditis due to combined assessment of postoperative cardiovascular dysfunction and IE related inflammatory response. We provided suggestive evidence that the amount of cardiovascular support represented as the VIS has a predictive value regarding mortality in patients undergoing valve replacement for IE. In addition, VIS showed superiority compared to conventional scoring systems for predicting outcome in the intensive care of postoperative IE patients.