Comparison of Predictive Powers for Mortality between Systemic Vascular Resistance Index and Serum Lactate in Children with Persistent Catecholamine-Resistant Shock

الملخص EN

Persistent catecholamine-resistant shock in children causes severe morbidity and mortality.

We aimed to analyze the association between hemodynamics and serum lactate at different time points and 28-day mortality in children with persistent catecholamine-resistant shock.

Methods.

Twenty-six children with persistent catecholamine-resistant shock were enrolled, and their hemodynamics were monitored using the pulse index continuous cardiac output.

Serial cardiac index (CI), systemic vascular resistant index (SVRI), and vasoactive-inotropic score (VIS) were analyzed for the first 24 hours.

Associations between hemodynamics, serum lactate, and 28-day mortality were analyzed.

Results.

The 28-day mortality rate was 53.8%.

SVRI and VIS were independent predictors of 28-day mortality.

The mortality group had lower serial SVRI and higher VIS than the survival group (p<0.05).

Serial SVRI had the highest area under the receiver operating characteristic curve (AUC) for predicting mortality during the first 24 hours of persistent catecholamine-resistant shock.

Three important hemodynamic parameters, CI, SVRI and perfusion pressure (MAP-CVP), were significantly correlated with lactate, of which SVRI had the best correlation (r=−0.711, p<0.001).

According to the AUC, SVRI was a more powerful predictor of mortality than lactate in persistent catecholamine-resistant shock.

After 24 hours of treatment for persistent catecholamine-resistant shock, an SVRI lower than 1284 dyn·s·cm-5·m2 was associated with 28-day mortality.

Conclusions.

SVRI was an early factor associated with mortality in the pediatric patients with persistent catecholamine-resistant shock potentially and had the good correlation with serum lactate.

An SVRI more than 1284 dyn·s·cm-5·m2 during the first 24 hours of persistent catecholamine-resistant shock was associated with favorable outcomes.

The result should be used with caution due to the small sample size.