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. 2018 Nov 22;8(1):112.
doi: 10.1186/s13613-018-0459-6.

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

Saraschandra Vallabhajosyula  1   2   3 , Jacob C Jentzer  4   5 , Aditya A Kotecha  6   7 , Dennis H Murphree Jr  8 , Erin F Barreto  6   8   9 , Ashish K Khanna  10   11 , Vivek N Iyer  5   6
Affiliations

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

Saraschandra Vallabhajosyula et al. Ann Intensive Care. .

Abstract

Background: Vasoactive 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.

Methods: Quantitative 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 results: The 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.

Conclusions: The 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.

Keywords: Inotropes; MAVIC model; Norepinephrine; Septic shock; Vasopressors.

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Figures

Fig. 1
Fig. 1
Vasoactive medication scoring systems. Conversion and scoring systems used in norepinephrine equivalents (1A), vasoactive inotrope score (1B) and cumulative vasopressor index (1C). All doses in mcg/kg/min except vasopressin, which is U/min. NEE norepinephrine equivalents
Fig. 2
Fig. 2
Study population. ICU intensive care unit
Fig. 3
Fig. 3
Discrimination of vasoactive scoring systems for 28-day mortality. AUROC curve for log10NEE = 0.63 (a); log10VIS = 0.61 (b); and log10CVI = 0.52 (c). AUROC area under receiver operating characteristic, CVI cumulative vasopressor index, NEE norepinephrine equivalents, VIS vasoactive inotrope score
Fig. 4
Fig. 4
Discriminatory ability of MAVIC model for 28-day mortality. AUROC curve for derivation (a) and validation cohorts (b) = 0.73. AUROC area under receiver operating characteristic, MAVIC Mechanical ventilation, APACHE-III, Vasopressors, Inotropes and Charlson comorbidity index
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