Background
Methods
Inclusion and exclusion criteria
Data collection
Definitions
Vasodilation criterion | Hemodynamic criterion | Vasopressor criterion | Preload criterion | Time moment/period | |
---|---|---|---|---|---|
Argenziano [1] | MAP < 70 mmHg | CI > 2.5 l·min− 1·m− 2 | nor > 8 μg·min− 1 | 5 min after CPB | |
Levin [2] | MAP < 50 mmHg and SVR < 800 dynes·s·cm− 5 | CI > 2.5 l·min− 1·m− 2 | any vasopressor | CVP < 5 mmHg and PCWP < 10 mmHg | first 3 h after ICU arrival |
Patarroyo [9] | SVR < 800 dynes·s·cm− 5 | CI > 2.5 l·min− 1·m− 2 | ≥ 2 vasopressors: 1. epi > 4 μg/min, 2. nor ≥4 μg/min, 3. dopa ≥5 μg· kg− 1·min− 1, 4. vasopressin ≥1 U/hr | 6–48 h after ICU arrival | |
Unified definition | MAP < 50 mmHg or SVR < 800 dynes·s·cm− 5 | CI > 2.5 l·min− 1·m− 2 | nor > 200 ng·kg− 1·min− 1 or equivalent doses of other vasopressors: epi ≥ 200 ng·kg− 1·min− 1; dopa ≥30 μg·kg− 1·min− 1; phenyl ≥2 μg·kg− 1·min− 1; or vasopressin ≥0.08 U·min− 1 | first 48 h after ICU arrival |
Outcomes
Statistical analysis
Results
Derivation cohort 118 patients | Validation cohort 72 patients | |
---|---|---|
Demographic data | ||
Age (years) | 49.4 ± 12.8 | 51.2 ± 13.0 |
Male gender | 83 (70.3%) | 49 (68.1%) |
Weight (kg) | 75.0 ± 14.0 | 75.6 ± 15.0 |
Height (cm) | 177 ± 9 | 174 ± 23 |
BSA (m2) | 1.92 ± 0.19 | 1.92 ± 0.22 |
BMI (kg·m−2) | 23.9 ± 4.1 | 24.1 ± 3.8 |
Indication LVAD implantation | ||
Hypertrophic CMP | 3 (2.5%) | 1 (1.4%) |
Ischemic CMP | 25 (21.2%) | 16 (22.2%) |
Non-compaction CMP | 5 (4.2%) | 0 (0.0%) |
Dilating CMP | 85 (72.0%) | 52 (72.2%) |
Myocarditis | 0 (0.0%) | 1 (1.4%) |
Congenital CMP | 0 (0.0%) | 1 (1.4%) |
Toxic CMP | 0 (0.0%) | 1 (1.4%) |
Medical History | ||
Diabetes Mellitus | 9 (7.6%) | 10 (13.9%) |
Hypertension | 10 (8.5%) | 10 (13.9%) |
Hypercholesterolemia | 12 (10.2%) | 11 (15.3%) |
Smoking history | 64 (54.2%) | 25 (34.7%) |
Thyroid disease | 15 (12.7%) | 7 (9.7%) |
COPD | 13 (11.0%) | 9 (12.5%) |
Stroke | 7 (5.9%) | 4 (5.6%) |
Transient Ischemic Attack | 6 (5.1%) | 3 (4.2%) |
Previous Cardiothoracic surgery | 14 (11.9%) | 13 (18.1%) |
HMIIRS | 2.4 ± 1.3 | 1.5 ± 1.0 |
Euroscore II | 22.1 [17.3–34.0] | 19.0 [12.3–34.7] |
Intermacs Class | ||
Intermacs class I | 15 (12.7%) | 1 (1.4%) |
Intermacs class II | 63 (53.4%) | 31 (43.1%) |
Intermacs class III | 33 (28.0%) | 27 (37.5%) |
Intermacs class IV | 7 (5.9%) | 12 (16.7%) |
Intermacs class V | 0 (0.0%) | 0 (0.0%) |
Intermacs class VI | 0 (0.0%) | 1 (1.4%) |
Incidence of vasoplegia
Association of vasoplegia with clinical outcomes
Prediction model
Argenziano | Univariable | Multivariable | |||||
Preoperative characteristics | No vasoplegia n = 90 | Vasoplegia n = 28 | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value |
Pre-op dobutamine | 43 (47.8%) | 19 (67.9%) | 0.04 | 2.65 (1.05–6.68) | 0.04 | 2.65 (1.05–6.68) | 0.04 |
Pre-op VIS | 4.3 [0.0–7.3] | 6.5 [4.0–11.9] | 0.03 | 1.03 (1.00–1.06) | 0.05 | ||
Neutrophil/ Lymphocyt –ratio | 4.5 [3.6–7.7] | 8.0 [5.6–9.5] | 0.04 | 1.13 (1.00 1.28) | 0.05 | ||
Levin | Univariable | Multivariable | |||||
Preoperative characteristics | No vasoplegia n = 115 | Vasoplegia n = 3 | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value |
NCCMP | 3 (2.6%) | 2 (66.7%) | < 0.01 | 74.67 (5.22–1067.12) | < 0.01 | 1.00 | |
DCMP | 85 (73.9%) | 0 (0.0%) | < 0.01 | 0.0 (0.0-∞) | 1.00 | ||
Clopidogrel | 6 (5.2%) | 1 (33.3%) | 0.04 | 9.08 (0.71–114.92) | 0.09 | ||
Insuline | 4 (3.5%) | 1 (33.3%) | 0.01 | 13.88 (1.03–186.60) | < 0.05 | 1.00 | |
Preop norepinephrine | 12 (10.4%) | 3 (100%) | < 0.01 | 17.17 (1.45–203.67) | 0.02 | 1.00 | |
Lactate | 1.9 [1.4–2.7] | 13.1 | 0.03 | ∞ (0.00-∞) | 0.98 | ||
Patarroyo | Univariable | Multivariable | |||||
Preoperative characteristics | No vasoplegia n = 109 | Vasoplegia n = 9 | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value |
Previous CT-surgery | 10 (9.2%) | 4 (44.4%) | < 0.01 | 7.92 (1.83–34.30) | < 0.01 | 10.4 (2.04–53.08) | < 0.01 |
Pre-op dopamine | 22 (20.2%) | 5 (55.5%) | 0.02 | 4.94 (1.22–19.96) | 0.03 | 6.46 (1.36–30.55) | 0.02 |
Unified definition | Univariable | Multivariable | |||||
Preoperative characteristics | No vasoplegia n = 79 | Vasoplegia n = 39 | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value |
Previous CT-surgery | 5 (6.3%) | 9 (23.1%) | < 0.01 | 4.44 (1.38–14.34) | 0.01 | 7.60 (1.98–29.24) | < 0.01 |
Euroscore II* | 20.6 [15.3–25.1] | 32.6 [20.6–42.2] | < 0.01 | 1.06 (1.03–1.10) | < 0.01 | ||
Pre-op dopamine | 13 (16.5%) | 14 (35.9%) | 0.02 | 2.84 (1.17–6.88) | 0.02 | 3.83 (1.28–11.46) | 0.02 |
Pre-op VIS | 4.1 [0.0–6.7] | 6.5 [4.0–10.6] | < 0.01 | 1.04 (1.00–1.08) | 0.06 | ||
Bilirubin (μmol·l−1) | 27.0 [15.5–37.3] | 36.0 [25.0–44.5] | < 0.01 | 1.04 (1.01–1.07) | < 0.01 | 1.04 (1.01–2.08) | < 0.01 |
Creatinine* (μmol·l−1) | 101 [91–150] | 157 [117–186] | 0.02 | 1.01 (1.01–1.02) | < 0.01 | ||
Creatinine Clearance (ml·min− 1) | 72 ± 29 | 57 ± 22 | < 0.01 | 0.97 (0.95–0.99) | < 0.01 | 0.97 (0.95–0.99) | < 0.01 |