Klompmaker P, Mousa A, Allard D J, Hagen B S H, Bánki T, Vermeulen W, de Waal M, van Wolfswinkel S, De Grooth H J S, Veelo D P, Vlaar A P J, Tuinman P R
Department of Intensive Care Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Amsterdam Leiden IC Focused Echography (ALIFE,www.alifeofpocus.com), the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
Department of Intensive Care Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Amsterdam Leiden IC Focused Echography (ALIFE,www.alifeofpocus.com), the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
J Crit Care. 2025 Aug;88:155097. doi: 10.1016/j.jcrc.2025.155097. Epub 2025 Apr 25.
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.
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.
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.
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.
静脉超声过度分级系统（VExUS）可在床边评估静脉淤血情况。关于VExUS是否与危重症患者的重要临床结局（如急性肾损伤（AKI））相关，存在相互矛盾的证据。主要目的是评估危重症患者中不同VExUS分级的患病率及其与AKI和30天死亡率的关联。次要目的是调查住院期间VExUS的变化情况，并评估VExUS检查在危重症患者中的可行性和一致性。
在荷兰一家三级医院重症监护病房（ICU）进行的单中心前瞻性队列研究。纳入预计入住ICU≥24小时且可行超声检查的连续成年危重症患者。在入院后48小时内进行VExUS检查，每隔一天重复一次，每位患者最多测量三次。主要结局是VExUS分级的患病率以及与入院后前30天内主要不良肾脏事件（MAKE-30）的关联，MAKE-30定义为血清肌酐升高≥两倍、使用肾脏替代治疗或死亡。
纳入138例患者，其中大多数为男性（67%），中位年龄为67.5岁[56 - 75岁]。VExUS 2级（8%）和3级（4%）的患病率较低，且VExUS分级在ICU入院后的前72小时内变化最大。即使校正其他变量后，VExUS≥2级与MAKE-30仍密切相关（比值比4.3 [95%置信区间1.2 - 20.7]）。最后，VExUS在评分者间和评分者内显示出中度至高度一致性。
在危重症患者中，VExUS 2级和3级的患病率较低。VExUS与相关患者结局密切相关，是评估静脉淤血的可靠工具。
