Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies
Abstract 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 Des...
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SpringerOpen
2025-03-01
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| Series: | The Ultrasound Journal |
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| Online Access: | https://doi.org/10.1186/s13089-025-00413-9 |
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| author | Rafael Hortêncio Melo Luciana Gioli-Pereira Edielle Melo Philippe Rola |
| author_facet | Rafael Hortêncio Melo Luciana Gioli-Pereira Edielle Melo Philippe Rola |
| author_sort | Rafael Hortêncio Melo |
| collection | DOAJ |
| description | Abstract 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; I2 = 74%). The association was notably stronger in cardiac surgery patients (OR 3.86, 95% CI 2.32–6.42; p < 0.00001; i2 = 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. Clinical Trial Registration: PROSPERO under protocol number CRD535513. |
| format | Article |
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| institution | OA Journals |
| issn | 2524-8987 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | SpringerOpen |
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| series | The Ultrasound Journal |
| spelling | doaj-art-e4a87ea4ad0544a5b60b603c843ccb8f2025-08-20T01:57:44ZengSpringerOpenThe Ultrasound Journal2524-89872025-03-011711810.1186/s13089-025-00413-9Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studiesRafael Hortêncio Melo0Luciana Gioli-Pereira1Edielle Melo2Philippe Rola3Hospital Municipal Vila Santa Catarina Dr.Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert EinsteinHospital Municipal Vila Santa Catarina Dr.Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert EinsteinHospital Municipal Vila Santa Catarina Dr.Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert EinsteinUniversity of MontrealAbstract 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; I2 = 74%). The association was notably stronger in cardiac surgery patients (OR 3.86, 95% CI 2.32–6.42; p < 0.00001; i2 = 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. Clinical Trial Registration: PROSPERO under protocol number CRD535513.https://doi.org/10.1186/s13089-025-00413-9Fluid resuscitationVenous congestionFluid responsivenessCritical careVExUSFluid tolerance |
| spellingShingle | Rafael Hortêncio Melo Luciana Gioli-Pereira Edielle Melo Philippe Rola Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies The Ultrasound Journal Fluid resuscitation Venous congestion Fluid responsiveness Critical care VExUS Fluid tolerance |
| title | Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies |
| title_full | Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies |
| title_fullStr | Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies |
| title_full_unstemmed | Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies |
| title_short | Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies |
| title_sort | venous excess ultrasound score association with acute kidney injury in critically ill patients a systematic review and meta analysis of observational studies |
| topic | Fluid resuscitation Venous congestion Fluid responsiveness Critical care VExUS Fluid tolerance |
| url | https://doi.org/10.1186/s13089-025-00413-9 |
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