OBJECTIVE: The aim of this study was to evaluate the vasoactive-inotropic score (VIS) as the predictor for postoperative acute kidney injury (AKI) in adult patients with cardiovascular surgery. DESIGN: Retrospective cohort study. SETTING: Single center. PARTICIPANTS: 1935 adult patients with cardiovascular surgery between September 2017 and May 2019. MEASUREMENTS AND MAIN RESULTS: We calculated VIS-max by using the highest doses of vasoactive and inotropic medications during the first 24h after cardiovascular surgery. In 1935 patients, 291 patients (15.0%) developed postoperative AKI from second day to seventh day after cardiovascular surgery, and 30 patients (1.6%) needed RRT. Multivariate logistic regression analysis showed that VIS-max was associated with postoperative AKI (odds ratio[OR]: 1.18, 95% confidence interval [CI]: 1.10-1.27, P<0.001) and need for RRT in AKI patients (OR: 1.04, 95%CI: 1.01-1.06, P=0.004). The area under the ROC curve (AUC) of VIS-max as a continuous variable was significantly than the AUC of EuroSOCRE, SOFA or APACHE II score as continuous variables ( VIS-max vs EuroSCORE: 0.81 vs 0.71, P<0.001, VIS-max vs SOFA score: 0.81 vs 0.67, P<0.001, VIS-max vs APACHE II score: 0.81 vs 0.68, P<0.001), and the optimal cutpoint of VIS-max was 7.5 points. The AUC of VIS-max for predicting need for RRT in patients with postoperative AKI was significantly higher than EuroSOCRE (0.75 vs 0.58, P=0.024), and the cut-off value was 12.5 points. CONCLUSIONS: VIS-max may be a useful tool in predicting postoperative AKI in adult patients after cardiovascular surgery.