Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study

Vimal Bhardwaj; Gunaseelan Vikneswaran; Philippe Rola; Siddharth Raju; Rammohan S Bhat; Arunkumar Jayakumar; Arjun Alva

doi:10.5005/jp-journals-10071-23570

Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study

Indian J Crit Care Med. 2020 Sep;24(9):783-789. doi: 10.5005/jp-journals-10071-23570.

Authors

Vimal Bhardwaj¹, Gunaseelan Vikneswaran², Philippe Rola³, Siddharth Raju⁴, Rammohan S Bhat⁵, Arunkumar Jayakumar⁵, Arjun Alva¹

Affiliations

¹ Department of Critical Care Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India.
² Department of Clinical Research, Narayana Hrudayalaya, Bengaluru, Karnataka, India.
³ Intensive Care Unit Services, Santa Cabrini Hospital, Montreal, Canada.
⁴ Department of Critical Care Medicine, Narayana Health City, Bengaluru, Karnataka, India.
⁵ Department of Nephrology, Narayana Health City, Bengaluru, Karnataka, India.

Abstract

Background: Fluid overload is deleterious in critically ill patients. It can lead to venous congestion, thereby increasing venous pressure, theoretically increasing the backpressure, and thereby reducing renal blood flow. Venous congestion thus can be an important contributor to acute kidney injury (AKI), with no validated tools to objectively identify venous congestion bedside.

Materials and methods: Patients above 18 years admitted in ICU with a provisional diagnosis of cardiorenal syndrome were included in the study. Those with inadequate window, inferior vena cava (IVC) thrombus, and known case of cirrhosis with portal hypertension were excluded from the study. Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis. Venous excess ultrasound score (VEXUS) comprising inferior vena cava, hepatic vein waveform, and portal vein pulsatility was assessed.

Results: Thirty patients were enrolled for the study. The mean age was 59.53 ± 16.47 with 21 (70%) males. Mean sequential organ failure assessment (SOFA) score was 5.03 ± 1.97. Fourteen patients (46.7%) were in AKI stage 1, while eight patients (26.7%) were in AKI stage 2 and stage 3 each. Twenty patients (66.7%) had VEXUS grade III. Resolution of AKI injury showed significant correlation with improvement in VEXUS grade (p value 0.003). Similarly, there was significant association between changes in VEXUS grade and fluid balance (p value 0.006). There was no correlation between central venous pressure (CVP), left ventricular function, and right ventricular function with change in VEXUS grade.

Conclusion: The study shows that a combined grading of IVC, hepatic vein, and portal vein might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal.

How to cite this article: Bhardwaj V, Vikneswaran G, Rola P, Raju S, Bhat RS, Jayakumar A, et al. Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study. Indian J Crit Care Med 2020;24(9):783-789.

Keywords: Acute kidney injury; Fluid balance; Portal vein pulsatility; Venous congestion; Volume overload.