The Use of the Venous Excess Ultrasound Score as a Bedside Tool to Predict Incidence of Acute Kidney Injury in Patients with Septic Shock, a prospective observational study

Background Assessment of venous congestion in septic shock patients is important, but it is often lacking due to the absence of a noninvasive bedside tool. The Venous Excess Ultrasound Grading System (VExUS) is an ultrasound score that has been associated with acute kidney injury (AKI) in cardiac patients. The objectives of this study were to assess the grade of congestion using VExUS in septic shock patients and to evaluate the correlation between serial VExUS scores and AKI, as well as the associations between VExUS scores and fluid balance, fluid overload, intensive care unit (ICU) stay duration, mechanical ventilation duration, and in-hospital mortality. Methods This was a prospective observational cohort study. We included 40 adult septic shock patients admitted to the ICU at Menoufia University Hospitals, following approval by the Ethics Committee. Patients with pregnancy, heart failure, portal hypertension, inferior vena cava thrombosis, and liver cirrhosis were excluded. Daily VExUS examinations were performed on the included patients, who were then monitored for the onset of new AKI. On day 7, patients were categorized based on changes in their VExUS scores into improving, unchanged, and worsening groups. Patients who developed AKI were followed until either the resolution of the AKI or the initiation of dialysis. Results The study enrolled forty patients, and those with AKI had higher VExUS scores (VExUS 2 and 3) than those without AKI, with significant differences on Days 2, 3, 4, and 6 of admission. Regarding VExUS status after one week, 50% of patients who developed AKI had worsening VExUS scores, compared to 16.7% of those without AKI, which is statistically significant. Furthermore, among AKI patients, 50% who improved their AKI parameters also showed improved VExUS scores, whereas none with worsening AKI parameters did. However, this change was not statistically significant. VExUS scores ≥ 2 demonstrated good specificity (83.3%) with a low false-positive rate. However, sensitivity was low (25%). Patients with worsening VExUS scores required dialysis more often (41.7%) than those with stable VExUS scores (12.5%), had longer durations of mechanical ventilation, and experienced higher mortality compared to other patients. Conclusion The VExUS score may be a useful predictor of AKI in patients with septic shock. Clinical trial registration : The study was registered in the Pan African Clinical Trials Registry: PACTR202409715853957, date:2/9/2024.