Vasoactive and inotropic agents are vital in sepsis treatment, but the link between the peak Vasoactive-Inotropic Score (VISmax) and patient outcomes in adults is not well understood. This study examined whether VISmax could serve as an early indicator of mortality in adult sepsis patients admitted to the emergency department (ED) and compared its predictive ability with the Sequential Organ Failure Assessment (SOFA) score. We conducted a single-center retrospective analysis of 910 sepsis patients between January 2016 and March 2020. VISmax was determined using the highest doses of administered vasopressors and inotropes within the first six hours of ED admission and classified into five categories: 0–5, 6–15, 16–30, 31–45, and >45. The main outcome measured was 30-day mortality. Mortality rates increased with higher VISmax: 17.2 percent, 20.8 percent, 33.3 percent, 54.6 percent, and 70.0 percent across the respective groups. A VISmax threshold of 31 points was identified as optimal for predicting mortality. VISmax outperformed the cardiovascular component of SOFA and initial lactate levels in prognostic accuracy and showed similar predictive value to the APACHE II score. Multivariable analysis confirmed that VISmax ranges of 16–30, 31–45, and >45 independently predicted 30-day mortality. Early VISmax assessment in the ED may therefore provide clinicians with a valuable tool to identify sepsis patients at higher risk of death.
