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. 2025 Jul 23;15(1):105.
doi: 10.1186/s13613-025-01529-w.

Association between the Venous Excess Ultrasound (VExUS) score and acute kidney injury in critically ill patients with sepsis: a multicenter prospective observational study

Jia Song  1 , Gongze Chen  1 , Detian Lai  2 , Li Zhong  3 , Haozhe Fan  4 , Weihang Hu  1 , Minjia Wang  1 , Caibao Hu  1 , Wenwei Chen  5 , Ziqiang Ming  6 , Shijin Gong  7 , Qiancheng Luo  8
Affiliations

Association between the Venous Excess Ultrasound (VExUS) score and acute kidney injury in critically ill patients with sepsis: a multicenter prospective observational study

Jia Song et al. Ann Intensive Care. .

Abstract

Background: Venous congestion is associated with adverse clinical outcomes in critically ill patients, yet its assessment remains challenging. Recently, the Venous Excess Ultrasound (VExUS) score has shown great potential as a non-invasive tool for assessing venous congestion in cardiac patients. However, the relationship between VExUS and clinical outcomes in patients with sepsis remains understudied. This study aims to evaluate the incidence of venous congestion based on VExUS assessment within the first 5 days of intensive care unit (ICU) admission in critically ill patients with sepsis, and to investigate the association between VExUS and clinical outcomes.

Methods: We conducted a prospective, observational study in four ICUs, enrolling adult patients with sepsis who stayed in the ICU for at least 24 h. VExUS assessments were performed on days 1 (within 24 h), 3 (48-72 h), and 5 (96-120 h) following ICU admission. Patients were classified according to VExUS score ≥ 2 or < 2. The primary outcome was the prevalence of acute kidney injury (AKI) during ICU stay, while secondary outcomes included 30-day mortality, ICU mortality, and requirement for renal replacement therapy (RRT).

Results: Among the 108 patients included, 18% (19 patients) showed VExUS score ≥ 2 on day 1 of ICU admission, and the prevalence progressively decreased to 15% (15 patients) by day 3 and 6% (6 patients) by day 5. The VExUS score ≥ 2 was not associated with AKI (OR 1.82, 95% CI 0.62-5.31, p = 0.274), 30-day mortality (OR 0.82, 95% CI 0.28-2.4, p = 0.711), ICU mortality (OR 1.12, 95% CI 0.41-3.04, p = 0.82), or requirement for RRT (OR 2.29, 95% CI 0.68-7.64, p = 0.179). There was no significant correlation between VExUS and central venous pressure (coefficient: - 0.019, 95% CI -0.01 to 0.05, p = 0.204).

Conclusion: In critically ill patients with sepsis, approximately 20% exhibit early (within 24 h of ICU admission) venous congestion, with the prevalence progressively decreasing over the subsequent 5 days. Venous congestion assessed by VExUS was not associated with the occurrence of AKI or with mortality.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2200066987. Registered 22 December 2022, https://www.chictr.org.cn/.

Keywords: Acute kidney injury; ICU; Mortality; Sepsis; Ultrasound; VExUS; Venous congestion.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by an independent ethics committee (protocol number: 2022-124K). All participants provided written informed consent to participate. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Alluvial diagram showing the temporal trajectory of VExUS scores on days 1, 3, and 5 following ICU admission. The blue color represents patients with VExUS scores < 2. The red color represents patients with VExUS scores ≥ 2
Fig. 2
Fig. 2
Violin plot depicting the distribution of CVP across different VExUS grades
See this image and copyright information in PMC

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