破解急性肾损伤密码：评估VExUS评分在危重症非心脏患者中的预测能力

Cracking the Code of AKI: Evaluating the Predictive Power of VExUS Scoring in Critically Ill Noncardiac Patients.

作者信息

Khan Waseem Ahmad, Saini Vikas, Goel Alisha, Valiyaparambath Anas

机构信息

Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Department of Anesthesia and Intensive Care, The ESSEX Cardiothoracic Centre, Basildon, United Kingdom.

出版信息

Indian J Crit Care Med. 2025 Mar;29(3):236-243. doi: 10.5005/jp-journals-10071-24924. Epub 2025 Feb 28.

DOI:10.5005/jp-journals-10071-24924

PMID:40110233

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11915390/

Abstract

BACKGROUND

Numerous signs of venous congestion exist, but each has limitations. Previous studies have shown the utility of venous excess ultrasound (VExUS) scoring in predicting acute kidney injury (AKI) in patients postcardiac surgery. This study aimed to evaluate whether serial VExUS scoring could predict AKI in intensive care unit (ICU) patients without cardiac conditions.

MATERIALS AND METHODS

This single-center observational study was conducted in the main ICU of PGIMER, Chandigarh, India. Thirty patients with an inferior vena cava (IVC) diameter of ≥2 cm and a normal biventricular function were included. Serial VExUS scoring was performed on admission and daily for up to six days or until AKI developed, whichever occurred first.

RESULTS

Among 30 participants, 22 (73.3%) developed AKI. In the AKI group, mean VExUS scores were 1.95 on day 2, 1.92 on day 3, and 3.0 on day 5 ( = 0.001, 0.003, and 0.002, respectively). A significant positive correlation was observed between VExUS scores and fluid balance on day 2 (ρ = 0.375, = 0.041) and day 3 (ρ = 0.579, = 0.006). Multivariate analysis showed no correlation between the VExUS score on day 2 and fluid balance, duration of mechanical ventilation, or ICU length of stay. No association was found between VExUS scores and 30-day mortality.

CONCLUSION

In critically ill noncardiac patients, VExUS scores do not predict AKI onset. However, higher daily fluid balance may moderately correlate with VExUS scores.

HOW TO CITE THIS ARTICLE

Khan WA, Saini V, Goel A, Valiyaparambath A. Cracking the Code of AKI: Evaluating the Predictive Power of VExUS Scoring in Critically Ill Noncardiac Patients. Indian J Crit Care Med 2025;29(3):236-243.

摘要

背景

存在多种静脉淤血迹象，但每种都有局限性。既往研究显示静脉过度超声（VExUS）评分在预测心脏手术后患者急性肾损伤（AKI）方面具有实用性。本研究旨在评估连续VExUS评分能否预测非心脏疾病重症监护病房（ICU）患者的AKI。

材料与方法

本单中心观察性研究在印度昌迪加尔PGIMER的主ICU进行。纳入30名下腔静脉（IVC）直径≥2 cm且双心室功能正常的患者。入院时及之后每天进行连续VExUS评分，最长6天，或直至发生AKI，以先发生者为准。

结果

30名参与者中，22名（73.3%）发生了AKI。在AKI组中，第2天VExUS平均评分为1.95，第3天为1.92，第5天为3.0（分别为P = 0.001、0.003和0.002）。在第2天（ρ = 0.375，P = 0.041）和第3天（ρ = 0.579，P = 0.006）观察到VExUS评分与液体平衡之间存在显著正相关。多因素分析显示第2天VExUS评分与液体平衡、机械通气时间或ICU住院时间之间无相关性。未发现VExUS评分与30天死亡率之间存在关联。