Venous Excess Ultrasound Score and Acute Kidney Injury in Patients With Acute Heart Failure.

BACKGROUND

Systemic venous congestion is associated with an increased risk of acute kidney injury (AKI) in critically ill patients. Venous Excess Ultrasound Score (VExUS) has been proposed as a noninvasive tool for assessing venous congestion based on ultrasonographic evaluation of the inferior vena cava, hepatic vein flow, portal vein pulsatility, and intrarenal Doppler flow.

OBJECTIVES

The authors aimed to evaluate the association between the VExUS score and AKI in patients with acute heart failure (AHF).

METHODS

Prospective study including patients with AHF (acute de novo and decompensated chronic heart failure). VExUS was performed within the first 8 hours of hospital stay. Patients were classified by presence of severe congestion (VExUS 0-1/2-3). The primary objective was AKI, defined by Kidney Disease: Improving Global Outcomes criteria. Secondary objectives included the composite of AKI, cardiogenic shock, and all-cause mortality.

RESULTS

A total of 109 patients were included. After ultrasound assessment, 41 (37.2%) were categorized as having significant congestion (VExUS >1). VExUS >1 was more frequent in chronic HF and in patients with right ventricular involvement. At each increasing VExUS grade, a higher proportion developed AKI: VExUS = 0 (29.2%), VExUS = 1 (44%), VExUS = 2 (66.6%), and VExUS = 3 (60.7%) (P = 0.008). A significantly increased risk of AKI (HR: 2.65; 95% CI: 1.39-5.07; P = 0.003) was found in patients with VExUS >1. Adjusted logistic regression showed VExUS >1 as the strongest predictor (OR: 4.60; 95% CI: 1.47-16.0) of AKI during hospital stay.

CONCLUSIONS

In AHF patients, the VExUS score is associated with AKI occurrence. Further studies are needed to clarify the role of VExUS assessment in HF.