Cracking the Code of AKI: Evaluating the Predictive Power of VExUS Scoring in Critically Ill Noncardiac Patients.

Abstract

Background: Numerous signs of venous congestion exist, but each has limitations. Previous studies have shown the utility of venous excess ultrasound (VExUS) scoring in predicting acute kidney injury (AKI) in patients postcardiac surgery. This study aimed to evaluate whether serial VExUS scoring could predict AKI in intensive care unit (ICU) patients without cardiac conditions.

Materials and methods: This single-center observational study was conducted in the main ICU of PGIMER, Chandigarh, India. Thirty patients with an inferior vena cava (IVC) diameter of ≥2 cm and a normal biventricular function were included. Serial VExUS scoring was performed on admission and daily for up to six days or until AKI developed, whichever occurred first.

Results: Among 30 participants, 22 (73.3%) developed AKI. In the AKI group, mean VExUS scores were 1.95 on day 2, 1.92 on day 3, and 3.0 on day 5 (p = 0.001, 0.003, and 0.002, respectively). A significant positive correlation was observed between VExUS scores and fluid balance on day 2 (ρ = 0.375, p = 0.041) and day 3 (ρ = 0.579, p = 0.006). Multivariate analysis showed no correlation between the VExUS score on day 2 and fluid balance, duration of mechanical ventilation, or ICU length of stay. No association was found between VExUS scores and 30-day mortality.

Conclusion: In critically ill noncardiac patients, VExUS scores do not predict AKI onset. However, higher daily fluid balance may moderately correlate with VExUS scores.

How to cite this article: Khan WA, Saini V, Goel A, Valiyaparambath A. Cracking the Code of AKI: Evaluating the Predictive Power of VExUS Scoring in Critically Ill Noncardiac Patients. Indian J Crit Care Med 2025;29(3):236-243.