Background Although many improvements in neonatal care have been achieved, mortality rates for sepsis and septic shock in newborns are still high. The vasoactive inotropic score (VIS) was designed and studied to predict mortality in different settings. There are currently no data on the predictive ability of the VIS for mortality in newborn patients with septic shock. Methods Patients with late-onset neonatal sepsis who required inotropes because of fluid-refractory septic shock during the study period were included in the study. Four distinct VIS values were calculated for each septic shock episode after inotropic treatment had begun, that is, at the initiation of inotropic treatment and at 24 and 48 h after inotropic treatment had begun, and the highest VIS (VISmax) at any time after initiation of inotropic agents. Results The 98 episodes studied were divided into two groups according to the outcomes of their sepsis episodes as survivors (n = 39) or nonsurvivors (n = 59). The areas under the curve of the VIS values for the prediction of mortality were the VISmax (0.819, p < 0.001), followed by the VIS48 (0.802, p < 0.001), VIS24 (0.762, p = 0.001) and VIS0 (0.699, p = 0.015). Patients with a VISmax of greater than 20 had significantly higher odds of mortality (p < 0.001, β = 14.7, 95% confidence interval [4.7–45.9]). Conclusion We found that the VISmax was an easy-to-use and helpful tool for predicting a poor outcome in neonatal sepsis. Physicians should be aware that the prognosis is poor for any newborn with a VIS of 20 or greater at any point after the onset of sepsis.

中文翻译：

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血管活性正性肌力评分作为新生儿感染性休克死亡率的预测指标

背景 尽管新生儿护理取得了很大进步，但新生儿败血症和败血性休克的死亡率仍然很高。血管活性正性肌力评分 (VIS) 的设计和研究旨在预测不同环境下的死亡率。目前没有关于 VIS 对感染性休克新生儿死亡率的预测能力的数据。方法 将在研究期间因液体难治性脓毒性休克而需要正性肌力药物的迟发性新生儿败血症患者纳入研究。在正性肌力治疗开始后，即在正性肌力治疗开始时以及正性肌力治疗开始后 24 和 48 小时，计算每个感染性休克发作的四个不同的 VIS 值，以及开始后任何时间的最高 VIS (VISmax)正性肌力剂。结果 根据脓毒症发作的结果将所研究的 98 例患者分为幸存者 (n = 39) 或非幸存者 (n = 59) 两组。用于预测死亡率的 VIS 值曲线下面积为 VISmax (0.819, p < 0.001)，其次是 VIS48 (0.802, p < 0.001)、VIS24 (0.762, p = 0.001) 和 VIS0 ( 0.699，p = 0.015）。VISmax 大于 20 的患者死亡率明显更高（p < 0.001，β = 14.7，95% 置信区间 [4.7–45.9]）。结论 我们发现 VISmax 是一种易于使用且有用的工具，可用于预测新生儿败血症的不良结局。医生应该意识到，在脓毒症发作后任何时候 VIS 为 20 或更高的任何新生儿的预后都很差。