Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies
Keywords:
Fluid resuscitation, Venous congestion, Fluid responsiveness, Critical care, VExUS, Fluid toleranceAbstract
Background; Systemic venous congestion assessed by the venous excess ultrasound score (VExUS), has been associated with acute kidney injury (AKI) in patients undergoing cardiac surgery. However, there is a lack of evidence of this association in the general critically ill patients.
Study Design and Methods; PubMed, Embase, and Cochrane databases were searched for observational prospective studies that included critically ill patients and analyzed VExUS score on the first day of admission to the ICU. The main outcome was occurrence of AKI. Secondary outcome was all‑cause mortality. Statistical analysis was performed using Review Manager 5.4.1. Odds ratios (OR) with 95% confidence interval were pooled using a random‑effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Publication bias was assessed via funnel plot and heterogeneity was examined with I2 statistics.
Results: Our analysis included 1036 patients from nine studies, of whom 17.4% presented venous congestion according to VExUS definition. In critically ill patients presenting with venous congestion (VExUS score ≥ 2), the incidence of AKI was significantly higher as compared with those without congestion (OR 2.63, 95% CI 1.06–6.54; p = 0.04; I 2 = 74%). The association was notably stronger in cardiac surgery patients (OR 3.86, 95% CI 2.32–6.42; p < 0.00001; i 2 = 0%). There was no significant association between venous congestion and all‑cause mortality (OR 1.25, 95% CI 0.71–2.19; p = 0.44; i2 = 8%).
Conclusions: These findings suggest that VExUS score may correlate with an elevation in the incidence AKI in critically ill patients, with a more pronounced effect observed within the subgroup of patients undergoing cardiac surgery. There was no statistically significant association between VExUS score and all‑cause mortality.
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