The association between venous excess ultrasound grading system (VExUS) and major adverse kidney events after 30 days in critically ill patients: A prospective cohort study

Background: The Venous Excess Ultrasound grading system (VExUS) can evaluate venous congestion at the bedside. There is conflicting evidence whether VExUS is associated with important clinical outcomes, such as acute kidney injury (AKI), in critically ill patients. The primary aim is to evaluate prevalence of different VExUS grades and its association with AKI and 30 day mortality in critically ill patients. Secondary aims are to investigate the change of VExUS during admission and to assess the feasibility and agreement of VExUS examinations in critically ill patients. Method: A single centre prospective cohort study in a tertiary hospital intensive care unit (ICU) in the Netherlands. Consecutive adult critically ill patients expected to be admitted to the ICU ≥ 24 h in whom ultrasound was feasible were included. VExUS was performed within 48 h of admission and repeated every other day with a maximum of three measurements per patient. Primary outcome was prevalence of VExUS grades and association with major adverse kidney events in the first 30 days after admission (MAKE-30) defined as a rise of ≥200 % in serum creatinine, use of renal replacement therapy or death. Results: 138 patients were included most of whom were male(67 %) with a median age of 67.5[56–75]. Prevalence of VExUS grade 2(8 %) and 3(4 %) was low and VExUS grades showed the most change within the first 72 h after ICU admission. VExUS grade ≥ 2 was strongly associated with MAKE-30 (OR 4.3 [95 % CI 1.2–20.7]), also when corrected for other variables. Lastly, VExUS showed moderate to excellent inter- and intra-rater agreement. Conclusions: In critically ill patients the prevalence of VExUS 2 and 3 is low. VExUS is strongly associated with relevant patient outcomes and is a reliable tool in assessing venous congestion.