Venous excess ultrasound (VExUS) score as a predictive tool of acute kidney injury in acute heart failure: a prospective study
F Ben Ghorbel, S Antit, L ZakhamaAbstract
Introduction
Owing to the bidirectional interplay between the heart and the kidney, acute kidney injury (AKI) is frequent in the setting of acute heart failure (AHF), arising from both renal hypoperfusion and systemic venous congestion, and is associated with substantial adverse outcomes.
Purpose
This study aimed to investigate the association between AKI and venous congestion using the Venous Excess Ultrasound (VExUS) Grading System.
Methods
This monocentric, prospective study with a cross-sectional assessment and longitudinal follow-up was conducted between February and December 2024. Consecutive adult patients (≥18 years) admitted to the intensive care unit for acute de novo heart failure (HF) or acute decompensation of chronic HF were considered for inclusion. Patients with chronic haemodialysis, severe baseline renal impairment (creatinine clearance <30 mL/min), liver cirrhosis, portal hypertension, or inferior vena cava thrombosis were not included. Clinical, biological, including renal function assessed at admission, at 48 hours, and at hospital discharge, and echocardiographic data were collected during the index hospitalisation, with follow-up at 1, 3, and 6 months after discharge to assess renal function. The VExUS score was systematically assessed at 24 hours after admission, at discharge, and at three-month follow-up.
Results
Among 87 patients admitted with AHF, 67 individuals (77.0%) developed AKI, of whom 53 (60.9%) experienced AKI during the index hospitalisation. Among patients with AKI, 62.7% had severe venous congestion defined by VExUS grade 3. In multivariable analysis, AKI was independently associated with VExUS grade 3 (OR 2.84 95% CI 1.01-9.21 p=0.047). The VExUS score showed strong discriminative performance for AKI prediction (AUC = 0.76). Among individual venous doppler components, intra-renal venous flow demonstrated the highest predictive accuracy, with an AUC of 0.77, and a monophasic pattern identified as the optimal cut-off with a high positive predictive value (90.9%).
Conclusion
Severe venous congestion, assessed by the VExUS score and defined as grade 3, was independently associated with AKI. This venous grading system represents a simple and reproducible tool for the multi-organ assessment of venous congestion and allows prediction of clinically relevant outcomes.