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.
Elfeky, H., Ali, M., AttaAllah, H., Fathy, Y., Fawzi, G., Helwa, A. (2025). 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.. EKB Journal Management System, 5(2), 34-54. doi: 10.21608/jicem.2025.428889
Hanady Mohammed Elfeky; Menna Atef Ali; Hatem Amin AttaAllah; Yasser Ibrahim Fathy; Gehad Mahmoud Fawzi; Ahmed Taha Helwa. "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.". EKB Journal Management System, 5, 2, 2025, 34-54. doi: 10.21608/jicem.2025.428889
Elfeky, H., Ali, M., AttaAllah, H., Fathy, Y., Fawzi, G., Helwa, A. (2025). '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.', EKB Journal Management System, 5(2), pp. 34-54. doi: 10.21608/jicem.2025.428889
Elfeky, H., Ali, M., AttaAllah, H., Fathy, Y., Fawzi, G., Helwa, A. 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.. EKB Journal Management System, 2025; 5(2): 34-54. doi: 10.21608/jicem.2025.428889

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.

The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 5, Issue 2, June 2025, Pages 34-54    PDF (852.95 K)
Document Type: Original papers
DOI: 10.21608/jicem.2025.428889
Authors
Hanady Mohammed Elfeky* 1; Menna Atef Ali2; Hatem Amin AttaAllah3; Yasser Ibrahim Fathy3; Gehad Mahmoud Fawzi4; Ahmed Taha Helwa5
1MD, Critical Care Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.
2M.B., B. Ch, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.
3PhD, Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.
4M.B., B. Ch, MSc, Critical Care Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, Egypt.
5MD, 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
Venous Excess Ultrasound Score; Acute Kidney Injury; Septic Shock; Bedside Ultrasound; Point of Care Ultrasound
References

  1. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021/11/01 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y
  2. Machado FR, Cavalcanti AB, Bozza FA, et al. The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study. Lancet Infect Dis. Nov 2017;17(11):1180-1189. doi:10.1016/s1473-3099(17)30322-5
  3. Bagshaw, Sean M et al. “Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes.” Clinical journal of the American Society of Nephrology : CJASN 2,3 (2007): 431-9. doi:10.2215/CJN.03681106
  4. Plataki, Maria et al. “Predictors of acute kidney injury in septic shock patients: an observational cohort study.” Clinical journal of the American Society of Nephrology : CJASN 6,7 (2011): 1744-51. doi:10.2215/CJN.05480610
  5. Bagshaw, Sean M et al. “Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy.” Intensive care medicine 35,5 (2009): 871-81. doi:10.1007/s00134-008-1367-2
  6. Natraj, Rajeswari et al. “Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right Ventricular Dysfunction.” Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine 28,5 (2024): 447-452. doi:10.5005/jp-journals-10071-24705
  7. Hoste, Eric A J et al. “Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study.” Intensive care medicine 41,8 (2015): 1411-23. doi:10.1007/s00134-015-3934-7
  8. Bhardwaj, Vimal et al. “Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study.” Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine 24,9 (2020): 783-789. doi:10.5005/jp-journals-10071-23570
  9. Koratala A, Ronco C, Kazory A. Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts. Cardiorenal Med 2022; 12:141–54. https://doi.org/10.1159/000526902.
  10. Beaubien-Souligny, William et al. “Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system.” The ultrasound journal 12,1 16. 9 Apr. 2020, doi:10.1186/s13089-020-00163-w
  11. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138.
  12. Singh S, Koratala A. Utility of Doppler ultrasound derived hepatic and portal venous waveforms in the management of heart failure exacerbation. Clin Case Rep. Aug 2020;8(8):1489-1493. doi:10.1002/ccr3.2908
  13. Rola P, Miralles-Aguiar F, Argaiz E, et al. Clinical applications of the venous excess ultrasound (VExUS) score: conceptual review and case series. The Ultrasound Journal. 2021/06/19 2021;13(1):32. doi:10.1186/s13089-021-00232-8
  14. Viana-Rojas JA, Argaiz E, Robles-Ledesma M, et al. Venous excess ultrasound score and acute kidney injury in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. Jul 7, 2023;12(7):413-419. doi:10.1093/ehjacc/zuad048
  15. Beaubien-Souligny W, Rola P, Haycock K, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. The Ultrasound Journal. 2020/04/09 2020;12(1):16. doi:10.1186/s13089-020-00163-w
  16. Prager R, Arntfield R, Wong MYS, et al. Venous congestion in septic shock quantified with point-of-care ultrasound: a pilot prospective multicentre cohort study. Can J Anaesth. May 2024;71(5):640-649. La congestion veineuse dans le choc septique quantifiée par échographie ciblée : une étude de cohorte prospective multicentrique pilote. doi:10.1007/s12630-024-02717-1
  17. Andrei S, Bahr PA, Nguyen M, Bouhemad B, Guinot PG. Prevalence of systemic venous congestion assessed by Venous Excess Ultrasound Grading System (VExUS) and association with acute kidney injury in a general ICU cohort: a prospective multicentric study. Crit Care. Jun 8 2023;27(1):224. doi:10.1186/s13054-023-04524-4
  18. Rihl MF, Pellegrini JAS, Boniatti MM. VExUS Score in the Management of Patients With Acute Kidney Injury in the Intensive Care Unit: AKIVEX Study. J Ultrasound Med. Nov 2023;42(11):2547-2556. doi:10.1002/jum.16288
  19. Bitar ZI, Maadarani OS, Elzoueiry MM, Abdelfatah M, Antony B, Elhabibi ME. Venous excess ultrasound score in patients with sepsis and cardiorenal syndrome. Critical Care & Shock. 2023;26(6)
  20. Menéndez-Suso JJ, Rodríguez-Álvarez D, Sánchez-Martín M. Feasibility and Utility of the Venous Excess Ultrasound Score to Detect and Grade Central Venous Pressure Elevation in Critically Ill Children. J Ultrasound Med. Jan 2023;42(1):211-220. doi:10.1002/jum.16057
  21. Gravina I, Meo A, La Verde A, Nappi F, Viggiano D. #1988 VExUS score as a method to guide diuretic treatment in CKD patients with congestive nephropathy by right heart failure. NDT.2024;39(Supplement_1):gfae069-1125-1988. doi:10.1093/ndt/gfae069.1125
 

Statistics
Article View: 117
PDF Download: 184