Vasoactive inotropic score and mortality in COVID-19 in pediatric intensive care unit
DOI:
https://doi.org/10.5327/prmj.174Keywords:
COVID-19, mortality, intensive care units, pediatric, pediatricsAbstract
Purpose: This study analyzed children with critical illness associated with SARS-CoV-2 infection, focusing on mortality aspects in three pediatric intensive care units (PICU) in Belém, Pará, Brazil. Methods: A multicenter prospective study including children from 1 month to 18 years old admitted in three pediatric intensive care units due to acute or late COVID-19 confirmed in the period from April 2020 to July 2022, from three hospitals in the Eastern Amazon, Brazil. The sample was divided into two groups, survivors and non-survivors, and was prospectively followed from the day of hospitalization to its respective outcome. Univariate and multivariate analyses using the Cox regression model and Kaplan-Meier curves for each quartile of the maximum Vasoactive Inotropic Score (VISmax) were used to determine risk factors for unfavorable outcomes. The significance level was defined at <0.05 bilaterally. For mortality prediction, the ROC curve for data was compared to PIM-3, PRISM-IV and PELOD-2 scores. Results: Among the sample studied, the male gender, black and brown ethnicity, malnutrition, comorbidities and presence of neurological events are statistically significant risk factors. The VIS, despite a low discriminative capacity, showed a strong association with mortality in patients in the PICU with SARS-CoV-2-related SARS-SR. Conclusion: The limitations of the study include the lack of international and national data on the correlation of VIS with SARS- CoV-2, emphasizing the need for more research in this area.
Downloads
References
Adeyinka A, Bailey K, Pierre L, Kondamudi N. COVID 19 infection: Pediatric perspectives. John Wiley and Sons; 2021. v. 2.
Nunes MDR, Pacheco ST de A, Costa CIA, da Silva JA, Xavier W da S, Victória JZ. Diagnostic tests and clinical characteristics of covid-19 in children: An integrative review. Texto Contexto Enferm. 2020;29:e20200156. https://doi.org/10.1590/1980-265X-TCE-2020-0156
Oliveira VS, Oliveira LG, Bastos GS, Dias LA, Pinto RM, Souza CSB. Fatores determinantes de evolução grave e crítica da COVID-19 em crianças: revisão sistemática e metanálise. Resid Pediatr. 2020;10(2):1-8. https://doi.org/10.25060/residpediatr-2020.v10n2-405
Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11(2):234-8. https://doi.org/10.1097/PCC.0b013e3181b806fc
Sik G, Inamlık A, Akçay N, Kesici S, Aygun F, Kendırlı T, et al. Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study. Pediatr Res. 2023;94(2):730-7. https://doi.org/10.1038/s41390-023-02518-0
World Health Organization (WHO). Multisystem inflammatory syndrome in children and adolescents with COVID-19 [Internet]. Geneva: WHO; 2020 [cited 2025 Mar 12]. Available from: https://www.who.int/news-room/commentaries/detail/ multisystem-inklammatory-syndrome-in-children-and-adolescents-with-covid-19
Ramı́rez M. Multiple organ dysfunction syndrome. Curr Probl Pediatr Adolesc Health Care. 2013;43(10):273-7. https://doi.org/10.1016/j.cppeds.2013.10.003
Mercier JC, DiSessa TG, Jarmakani JM, Nakanishi T, Hiraishi S, Isabel-Jones J, et al. Two- dimensional echocardiographic assessment of left ventricular volumes and ejection fraction in children. Circulation. 1982;65(5):962-9. https://doi.org/10.1161/01.CIR.65.5.962
Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H, et al. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA. 2021;325(11):1074-87. https://doi.org/10.1001/jama.2021.2091
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis- associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21(2):e52-106. https://doi.org/10.1097/pcc.0000000000002198
Emeriaud G, López-Fernández YM, Iyer NP, Bembea MM, Agulnik A, Barbaro RP, et al. Executive summary of the second international guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143-68. https://doi.org/10.1097/pcc.0000000000003147
Summary of Recommendation Statements. Kidney Int Suppl (2011). 2011;2(1):8-12. https://doi.org/10.1038/kisup.2012.7
Acevedo L, Piñeres-Olave BE, Niño-Serna LF, Vega LM, Gomez IJA, Chacón S, et al. Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study). BMC Pediatr. 2021;21(1):516. https://doi.org/10.1186/s12887-021-02974-9
Kazi MA, Roychowdhury S, Ghosh S, Mahapatra MK, Bhakta S, Konar MC, et al. Characteristics and predictors of outcomes of critically Ill children with SARS-CoV-2 infection - the PICU experience. J Pediatr (Rio J). 2022;98(5):504-12. https://doi.org/10.1016/j.jped.2021.12.006
Salman H, Aslan N, Akçam M, Arslan M, Akkuzu E, Yllmaz Keskin E, et al. COVID-19-associated multisystem inflammatory syndrome in children: Experiences of three centres in Turkey. Mod Rheumatol. 2022;32(2):460-6. https://doi.org/10.1093/mr/roab042
Dipasquale V, Cucinotta U, Romano C. Acute malnutrition in children: pathophysiology, clinical effects and treatment. Nutrients. 2020;12(8):2413. https://doi.org/10.3390/nu12082413
Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324-9. https://doi.org/10.1111/jth.14859
Chang JC, Matsubara D, Morgan RW, Diorio C, Nadaraj S, Teachey DT, et al. Skewed cytokine responses rather than the magnitude of the cytokine storm may drive cardiac dysfunction in multisystem inflammatory syndrome in children. J Am Heart Assoc. 2021;10(16):e021428. https://doi.org/10.1161/jaha.121.021428
de Farias ECF, Pavão Junior MJC, de Sales SCD, do Nascimento LMPP, Pavão DCA, Pinheiro APS, et al. Factors associated to mortality in children with critical COVID-19 and multisystem inflammatory syndrome in a resource-poor setting. Sci Rep. 2024;14(1):5539. https://doi.org/10.1038/s41598-024-55065-x
