Association between the Venous Excess Ultrasound (VExUS) score and acute kidney injury in critically ill patients with sepsis: a multicenter prospective observational study.

IF 5.5 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2025-07-23 DOI:10.1186/s13613-025-01529-w

Jia Song, Gongze Chen, Detian Lai, Li Zhong, Haozhe Fan, Weihang Hu, Minjia Wang, Caibao Hu, Wenwei Chen, Ziqiang Ming, Shijin Gong, Qiancheng Luo

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Abstract

Background: Venous congestion is associated with adverse clinical outcomes in critically ill patients, yet its assessment remains challenging. Recently, the Venous Excess Ultrasound (VExUS) score has shown great potential as a non-invasive tool for assessing venous congestion in cardiac patients. However, the relationship between VExUS and clinical outcomes in patients with sepsis remains understudied. This study aims to evaluate the incidence of venous congestion based on VExUS assessment within the first 5 days of intensive care unit (ICU) admission in critically ill patients with sepsis, and to investigate the association between VExUS and clinical outcomes.

Methods: We conducted a prospective, observational study in four ICUs, enrolling adult patients with sepsis who stayed in the ICU for at least 24 h. VExUS assessments were performed on days 1 (within 24 h), 3 (48-72 h), and 5 (96-120 h) following ICU admission. Patients were classified according to VExUS score ≥ 2 or < 2. The primary outcome was the prevalence of acute kidney injury (AKI) during ICU stay, while secondary outcomes included 30-day mortality, ICU mortality, and requirement for renal replacement therapy (RRT).

Results: Among the 108 patients included, 18% (19 patients) showed VExUS score ≥ 2 on day 1 of ICU admission, and the prevalence progressively decreased to 15% (15 patients) by day 3 and 6% (6 patients) by day 5. The VExUS score ≥ 2 was not associated with AKI (OR 1.82, 95% CI 0.62-5.31, p = 0.274), 30-day mortality (OR 0.82, 95% CI 0.28-2.4, p = 0.711), ICU mortality (OR 1.12, 95% CI 0.41-3.04, p = 0.82), or requirement for RRT (OR 2.29, 95% CI 0.68-7.64, p = 0.179). There was no significant correlation between VExUS and central venous pressure (coefficient: - 0.019, 95% CI -0.01 to 0.05, p = 0.204).

Conclusion: In critically ill patients with sepsis, approximately 20% exhibit early (within 24 h of ICU admission) venous congestion, with the prevalence progressively decreasing over the subsequent 5 days. Venous congestion assessed by VExUS was not associated with the occurrence of AKI or with mortality.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2200066987. Registered 22 December 2022, https://www.chictr.org.cn/.

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一项多中心前瞻性观察研究：危重症脓毒症患者静脉超声（VExUS）评分与急性肾损伤之间的关系

背景：静脉充血与危重患者的不良临床结果相关，但其评估仍然具有挑战性。最近，静脉过量超声（VExUS）评分显示出作为评估心脏患者静脉充血的非侵入性工具的巨大潜力。然而，在脓毒症患者中，VExUS与临床结果之间的关系仍有待进一步研究。本研究旨在评估重症脓毒症患者入院前5天内静脉充血的发生率，并探讨VExUS与临床结局的关系。方法：我们在4个ICU中进行了一项前瞻性观察性研究，纳入了在ICU住院至少24小时的成年脓毒症患者。在ICU入院后第1天（24小时内）、第3天（48-72小时）和第5天（96-120小时）进行了VExUS评估。根据患者的VExUS评分≥2分或结果进行分类：纳入的108例患者中，18%（19例）患者在ICU入院第1天的VExUS评分≥2分，到第3天患病率逐渐下降至15%（15例），到第5天患病率逐渐下降至6%（6例）。VExUS评分≥2与AKI （OR 1.82, 95% CI 0.62-5.31, p = 0.274）、30天死亡率（OR 0.82, 95% CI 0.28-2.4, p = 0.711）、ICU死亡率（OR 1.12, 95% CI 0.41-3.04, p = 0.82）或RRT需求（OR 2.29, 95% CI 0.68-7.64, p = 0.179）无关。VExUS与中心静脉压无显著相关性（系数：- 0.019,95% CI -0.01 ~ 0.05, p = 0.204）。结论：危重症脓毒症患者中，约20%出现早期（入院24小时内）静脉充血，其后5天患病率逐渐下降。通过VExUS评估的静脉充血与AKI的发生或死亡率无关。试验注册：中国临床试验注册中心，ChiCTR2200066987。2022年12月22日注册，网址：https://www.chictr.org.cn/。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.