Validation of the Vasoactive-Ventilation-Renal Score as a Predictor of
Prolonged Intensive Care Unit Stay and Mortality After Critical
Congenital Heart Surgery in Neonates
Objectives: We aimed to validate the vasoactive-ventilation-renal (VVR)
score and to compare with other indices as a predictor of outcome in
neonates recovering from surgery for critical congenital heart disease.
We also sought to determine the optimal time at which VVR score should
be measured. Methods: We retrospectively reviewed neonates recovering
from cardiac surgery between July 2017 and June 2020. The VVR score was
calculated at admission, 24, 48 and 72 hours postoperatively. Max
values, defined as the highest of the four measurements were also noted.
Main outcome of interest was composite outcome which is prolonged
intensive care unit stay plus mortality. Receiver operating
characteristic curves were generated, and areas under the curve with
95% confidence intervals were calculated for all time points.
Multivariable logistic regression modelling was also performed. Results:
We reviewed 73 neonates and 21 of patients had composite outcome. The
area under the curve value for VVR score as a predictor of composite
outcome was greatest at postoperative 72 hour max (AUC= 0,967; 95%
confidence interval, (0,927-1). On multivariable regression analysis,
the VVR max 72 hour VVR score remained a strong independent predictor of
prolonged ICU stay and mortality (odds ratio, 1.4 52; 95% confidence
interval, 1.036 – 2.035). Conclusions: We validated the utility of the
VVR score in neonatal cardiac surgery for critical congenital heart
disease. The VVR follow up in postoparative 72 hours is superior to
other indeces and especially the maximum VVR value is potentially
powerful clinical tool to predict ICU stay and mortality.