Aslaner Mehmet Ali, Helvacı Özant, Haycock Korbin, Kılıçaslan İsa, Yaşar Emre, Cerit Mahi Nur, Şendur Halit Nahit, Güz Galip, Demircan Ahmet
Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.
Emerg Med J. 2024 Apr 22;41(5):304-310. doi: 10.1136/emermed-2023-213241.
Management of acute kidney injury (AKI) in the ED can be difficult due to uncertainty regarding the aetiology. This study investigated the diagnostic value of venous system ultrasound for determining the aetiological subtypes of AKI in the ED.
This multidisciplinary prospective cohort study was conducted in a single academic ED over the course of a year. Adult patients with AKI were evaluated using the venous excess ultrasound (VExUS) score, which is a four-step ultrasound protocol. The protocol begins with the inferior vena cava (IVC) measurement and examines organ flow patterns, including portal, hepatic and renal veins in the presence of dilated IVC. The AKI subtypes (hypovolaemia, cardiorenal, systemic vasodilatation and renal) were adjudicated by nephrologists and emergency physicians, considering data that became available during the hospitalisation. We determined the diagnostic test characteristics of VExUS for identifying each of the four AKI aetiological subtypes.
150 patients with AKI were included in the study. Hypovolaemia was the most frequent finally adjudicated cause of AKI (66%), followed by cardiorenal (18%), systemic vasodilatation (8.7%) and renal (7.3%). In diagnosing the cardiorenal subtype, the area under the curve (AUC) for VExUS grade >0 was 0.819, with 77.8% sensitivity and 80.5% specificity, and the AUC for IVC maximum diameter >20.4 mm was 0.865, with 74.1% sensitivity and 86.2% specificity. For the hypovolaemia subtype, the AUC for VExUS grade ≤0 was 0.711, with 83.8% sensitivity and 56.9% specificity, and the AUC for IVC maximum diameter ≤16.8 mm was 0.736, with 73.7% sensitivity and 68.6% specificity. None of the parameters achieved adequate test characteristics for renal and systemic vasodilatation subtypes.
The VExUS score has good diagnostic accuracy for cardiorenal AKI and fair accuracy for hypovolaemic AKI but cannot identify renal and systemic vasodilatation subtypes. It should not therefore be used in isolation to determine the cause of AKI in the ED.
NCT04948710.
由于病因不明，急诊科急性肾损伤（AKI）的管理可能具有挑战性。本研究调查了静脉系统超声在确定急诊科AKI病因亚型方面的诊断价值。
本多学科前瞻性队列研究在一家学术急诊科进行，为期一年。对成年AKI患者采用静脉过剩超声（VExUS）评分进行评估，这是一种四步超声检查方案。该方案首先测量下腔静脉（IVC），并在IVC扩张的情况下检查器官血流模式，包括门静脉、肝静脉和肾静脉。AKI亚型（低血容量性、心肾性、全身血管扩张性和肾性）由肾病学家和急诊科医生根据住院期间获得的数据进行判定。我们确定了VExUS用于识别四种AKI病因亚型中每一种的诊断试验特征。
150例AKI患者纳入本研究。低血容量是最终判定的最常见AKI病因（66%），其次是心肾性（18%）、全身血管扩张性（8.7%）和肾性（7.3%）。在诊断心肾亚型时，VExUS分级>0的曲线下面积（AUC）为0.819，敏感性为77.8%，特异性为80.5%；IVC最大直径>20.4 mm时的AUC为0.865，敏感性为74.1%，特异性为86.2%。对于低血容量亚型，VExUS分级≤0的AUC为0.711，敏感性为83.8%，特异性为56.9%；IVC最大直径≤16.8 mm时的AUC为0.736，敏感性为73.7%，特异性为68.6%。对于肾性和全身血管扩张性亚型，没有一个参数具有足够的试验特征。
VExUS评分对心肾性AKI具有良好的诊断准确性，对低血容量性AKI具有中等准确性，但无法识别肾性和全身血管扩张性亚型。因此，在急诊科不应单独使用它来确定AKI的病因。
NCT04948710。
