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.

Document Type : Original papers

Authors

1 MD, Critical Care Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.

2 M.B., B. Ch, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.

3 PhD, Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.

4 M.B., B. Ch, MSc, Critical Care Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.

5 MD, Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.

Abstract

Background: Septic shock is a life-threatening condition in critically ill patients, and fluid therapy is one of the main pillars in its management. However, excessive fluid accumulation can lead to venous congestion, which adversely affects renal blood flow and function. Objectives: This study aims to determine the predictive value of the VExUS score for acute kidney injury (AKI) in patients with septic shock, based on the hypothesis that identifying venous congestion early may help predict AKI. Methods: An observational cohort study was conducted at Menoufia University Hospital. Daily VExUS examinations were performed on forty adult patients with septic shock for 7 days, and patients were monitored for AKI development. On day 7, we categorized patients into AKI and non-AKI groups, and based on changes in VExUS scores, we classified them into improving, unchanged, or worsening groups. We followed AKI patients until they resolved or initiated renal replacement therapy. Results: Among the 40 patients, those who developed AKI exhibited higher VExUS scores compared to those without AKI. After one week, 50% of AKI patients had worsening VExUS scores, needed more dialysis, required longer mechanical ventilation, and had higher mortality. The diagnostic performance of VExUS ≥ 2 on admission for predicting AKI showed good specificity (83.3%). However, sensitivity was low (25%). Conclusion: The VExUS score may predict AKI in patients with septic shock.

Keywords

References

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