[Predictive value of the Vasoactive Inotropic Score for 28-day mortality in patients with atrial fibrillation-related hemodynamic deterioration in the intensive care unit].
To evaluate the predictive value of the Vasoactive Inotropic Score (VIS) for 28-day mortality in intensive care unit (ICU) patients with atrial fibrillation (AF)-related hemodynamic deterioration, to determine its optimal cutoff value, and to analyze its independent association with 28-day mortality risk.
A retrospective cohort study was conducted. Patients with AF-related hemodynamic deterioration treated in the Department of Critical Care Medicine of Sichuan Provincial People's Hospital from September 2020 to May 2025 were enrolled. General clinical data, laboratory indices at ICU admission, arterial blood gas analysis and vital signs at AF onset, and the peak VIS within 48 hours of AF onset were collected through the electronic medical record system. According to the 28-day outcome, the patients were divided into a survivor group and a non-survivor group. Clinical data were compared between the two groups. Receiver operator characteristic curve (ROC curve) analysis was performed to evaluate the predictive value of VIS for 28-day mortality and to determine its optimal cutoff value. After stratifying patients by VIS using the optimal cut off value, variables with statistically significant differences in univariate analysis were entered into a multivariable logistic regression model to identify independent predictors of 28-day mortality. An ROC curve was further plotted to evaluate the predictive performance of the combined predictive model.
A total of 123 ICU patients who met the definition of AF-related hemodynamic deterioration were identified through retrospective review of continuous electrocardiographic monitoring records and expert adjudication. Among them, 68 died and 55 survived within 28 days. Univariate analysis showed that, compared with the survivor group, patients in the non-survivor group were older, had higher proportions of diabetes mellitus, sepsis, and severe pneumonia, were more likely to receive continuous renal replacement therapy (CRRT), and had a lower proportion of postoperative cardiac surgery patients. The levels of the VIS, Acute Physiology and Chronic Health Evaluation II(APACHE II), Sequential Organ Failure Assessment (SOFA), CHA2DS2-VASc score, HAS-BLED score, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and lactic acid (Lac) at AF onset were higher in the non-survivor group than in the survivor group. In contrast, the proportion of patients receiving anticoagulation therapy, bicarbonate (HCO3-) levels at AF onset, and mean arterial pressure (MAP) at AF onset were lower, while the total length of hospital stay was shorter (all P<0.05). ROC curve analysis showed that VIS had good predictive performance for 28-day mortality, with an area under the curve (AUC) of 0.801 [95% confidence interval (95%CI) was 0.722-0.880, P<0.001]. When the optimal cutoff value of VIS was 129.705, the sensitivity was 61.8%, the specificity was 92.7%, and the Youden index was 0.545. Multivariable logistic regression analysis showed that VIS≥129.705 was an independent risk factor for 28-day mortality [odds ratio (OR)=70.532, 95%CI was 10.043-495.320, P<0.001], whereas anticoagulation therapy was an independent protective factor (OR=0.073, 95%CI was 0.006-0.870, P=0.038). Variables including age, history of diabetes mellitus, cardiac surgery, and CRRT were not significantly associated with 28-day mortality (all P>0.05). The combined prediction of anticoagulation and VIS≥129.705 achieved an AUC of 0.938 (95%CI was 0.898-0.977, P<0.001), with a sensitivity of 92.6% and a specificity of 81.8%, indicating good predictive performance.
VIS can effectively predict 28-day mortality in ICU patients with AF-related hemodynamic deterioration. The optimal cutoff value was 129.705, and VIS≥129.705 was an independent risk factor for 28-day mortality in this population. The combined predictive model based on VIS exhibited favorable predictive performance and may serve as a bedside reference tool for early identification of high-risk patients, facilitating clinical risk stratification and individualized therapeutic optimization.
A retrospective cohort study was conducted. Patients with AF-related hemodynamic deterioration treated in the Department of Critical Care Medicine of Sichuan Provincial People's Hospital from September 2020 to May 2025 were enrolled. General clinical data, laboratory indices at ICU admission, arterial blood gas analysis and vital signs at AF onset, and the peak VIS within 48 hours of AF onset were collected through the electronic medical record system. According to the 28-day outcome, the patients were divided into a survivor group and a non-survivor group. Clinical data were compared between the two groups. Receiver operator characteristic curve (ROC curve) analysis was performed to evaluate the predictive value of VIS for 28-day mortality and to determine its optimal cutoff value. After stratifying patients by VIS using the optimal cut off value, variables with statistically significant differences in univariate analysis were entered into a multivariable logistic regression model to identify independent predictors of 28-day mortality. An ROC curve was further plotted to evaluate the predictive performance of the combined predictive model.
A total of 123 ICU patients who met the definition of AF-related hemodynamic deterioration were identified through retrospective review of continuous electrocardiographic monitoring records and expert adjudication. Among them, 68 died and 55 survived within 28 days. Univariate analysis showed that, compared with the survivor group, patients in the non-survivor group were older, had higher proportions of diabetes mellitus, sepsis, and severe pneumonia, were more likely to receive continuous renal replacement therapy (CRRT), and had a lower proportion of postoperative cardiac surgery patients. The levels of the VIS, Acute Physiology and Chronic Health Evaluation II(APACHE II), Sequential Organ Failure Assessment (SOFA), CHA2DS2-VASc score, HAS-BLED score, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and lactic acid (Lac) at AF onset were higher in the non-survivor group than in the survivor group. In contrast, the proportion of patients receiving anticoagulation therapy, bicarbonate (HCO3-) levels at AF onset, and mean arterial pressure (MAP) at AF onset were lower, while the total length of hospital stay was shorter (all P<0.05). ROC curve analysis showed that VIS had good predictive performance for 28-day mortality, with an area under the curve (AUC) of 0.801 [95% confidence interval (95%CI) was 0.722-0.880, P<0.001]. When the optimal cutoff value of VIS was 129.705, the sensitivity was 61.8%, the specificity was 92.7%, and the Youden index was 0.545. Multivariable logistic regression analysis showed that VIS≥129.705 was an independent risk factor for 28-day mortality [odds ratio (OR)=70.532, 95%CI was 10.043-495.320, P<0.001], whereas anticoagulation therapy was an independent protective factor (OR=0.073, 95%CI was 0.006-0.870, P=0.038). Variables including age, history of diabetes mellitus, cardiac surgery, and CRRT were not significantly associated with 28-day mortality (all P>0.05). The combined prediction of anticoagulation and VIS≥129.705 achieved an AUC of 0.938 (95%CI was 0.898-0.977, P<0.001), with a sensitivity of 92.6% and a specificity of 81.8%, indicating good predictive performance.
VIS can effectively predict 28-day mortality in ICU patients with AF-related hemodynamic deterioration. The optimal cutoff value was 129.705, and VIS≥129.705 was an independent risk factor for 28-day mortality in this population. The combined predictive model based on VIS exhibited favorable predictive performance and may serve as a bedside reference tool for early identification of high-risk patients, facilitating clinical risk stratification and individualized therapeutic optimization.