Prognostic Value of Vasoactive-Inotropic Score in Critically Ill Children Receiving Extracorporeal Organ Support: A Retrospective Cohort Study

Objective: Extracorporeal therapies, including continuous renal replacement therapy (CRRT), therapeutic plasma exchange (TPE), and extracorporeal membrane oxygenation (ECMO), are applied in the most critically ill pediatric intensive care unit (PICU) patients. This study aimed to compare the predictive performance of the Pediatric Risk of Mortality (PRISM) score, Pediatric Logistic Organ Dysfunction (PELOD) score, and Vasoactive-Inotropic Score (VIS) for PICU mortality and to identify independent outcome predictors.Methods: A single-center retrospective cohort study included patients aged 1 month–18 years receiving CRRT, TPE, or ECMO at a tertiary PICU (January 2015–December 2020). Survivors and non-survivors were compared using Mann-Whitney U and chi-square tests. Discriminative ability was assessed by ROC curve analysis. Independent predictors were identified by binary logistic regression.Results: A total of 106 patients were enrolled (median age 64 months, 57.5% male); overall mortality was 43.4% (n=46). CRRT was applied in 84.9%, TPE in 30.2%, and ECMO in 5.7%. Non-survivors had significantly higher PRISM, PELOD, and peak VIS (all p21.25, sensitivity 82.6%, specificity 75.0%, PPV 71.7%, NPV 84.9%), followed by PELOD (AUC 0.849) and PRISM (AUC 0.821). Peak VIS was the sole independent predictor in both models (OR 1.036, 95% CI 1.016–1.056, p