Association of VISmax Score with Outcome in Critically-ill Children: A Prospective Cohort Study

Introduction: Sepsis is a leading cause of morbidity, mortality and hospitalisation. Severity score is therefore vital to improve the outcome of patients with sepsis and septic shock. VISmax score (Maximum Vasoactive-Inotropic Score) is simpler and easier to use compared to other scales such as Paediatric Risk of Mortality Score (PRISM) Paediatric Logistic Organ Dysfunction score (PELOD) and Paediatric Sequential Organ Failure Assessment score (pSOFA) score. Aim: To determine the association of VISmax score with outcome of critically-ill children in Paediatric Intensive Care Unit (PICU) and also to evaluate the association between VISmax score and PRISM III score to predict the outcome in PICU. Materials and Methods: This prospective cohort study was done in PICU of a Gandhi Medical College and associated Hamidiya hospital, a tertiary care hospital of central India during the period of September 2022- October 2023. The study population included 330 critically-ill children between 1-13 years of age with the requirement of Vasoactive medications since admission. Maximal VIS score (VISmax) in the initial six hours after admission was calculated using the highest doses of vasoactive and inotropic medications administered. Five categories of VISmax were established: 0-5, >5-15, >15-30, >30-45, and >45 points. The association of different categories of VISmax with outcome of children in term of mortality was evaluated using Student’s t-test. Results: A total of 330 patients satisfying the inclusion criteria were included in study with a mean age of five years (IQR 1-13 years) and male (n=188) outnumbered female. The median VISmax was 10.0 (IQR: 0.0-37.0). The (median (IQR) VISmax of non survivors was significantly higher than that of survivors (37.0 (10-54.0) vs. 5.0 (5.0-18.0); p-value