Correlation between venous excess ultrasound and acute kidney injury in patients with sepsis: A pilot study

Muhamed Hanizar Hajanajumudin; Muhaimin Noor Azhar; Aida Bustam; Aliyah Zambri; Khadijah Poh

doi:10.4103/tjem.tjem_173_25

Muhamed Hanizar Hajanajumudin, Muhaimin Noor Azhar, Aida Bustam, Aliyah Zambri, Khadijah Poh

Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

Keywords: Acute kidney injury, Doppler ultrasound, mortality, multiple organ dysfunction syndrome, sepsis, venous congestion

Abstract

OBJECTIVES: Venous congestion is increasingly recognized as a contributor to acute kidney injury (AKI) in critically ill patients. The venous excess ultrasound (VExUS) score has been proposed to assess systemic venous congestion, but its role in emergency department (ED) sepsis remains underexplored. This pilot study investigated the association between VExUS scores, development of AKI, and other outcomes in septic ED patients.

METHODS: This was a prospective observational pilot study conducted from July 2023 to December 2023 in a university affiliated tertiary ED. Adult patients with sepsis and an inferior vena cava diameter ≥2 cm after initial resuscitation were enrolled. VExUS was assessed at enrolment. The primary outcome was AKI within 72 h based on the Kidney Disease Improving Global Outcomes criteria. Secondary outcomes included mortality, organ dysfunction scores, and other outcomes. Associations were analyzed using Kendall’s tau b correlation and group comparisons with Mann–Whitney U test.

RESULTS: Thirty one patients were included, mean age 64.2 years. VExUS scores were Grade 1 in 64.5%, Grade 2 in 25.8%, and Grade 3 in 9.7%. Median VExUS scores did not differ between patients with and without AKI (2.0 [2.0–3.0] vs. 2.0 [2.0–3.0], P = 0.729), died and survived at 28 days (2.0 [2.0–2.25] vs. 2.0 [2.0–3.0], P = 0.419) or 60 days (2.0 [2.0–3.0] vs. 2.0 [2.0–3.0], P = 0.693). VExUS showed moderate correlations with creatinine (τ = 0.392, P = 0.004), sequential organ failure assessment (τ =0.267, P = 0.041), and inotrope requirements (τ = 0.299, P = 0.041).

CONCLUSION: In septic ED patients, VExUS was not associated with AKI or mortality but correlated with markers of organ dysfunction.

How to cite this article: Hajanajumudin MH, Azhar MN, Bustam A, Zambri A, Poh K. Correlation between venous excess ultrasound and acute kidney injury in patients with sepsis: A pilot study. Turk J Emerg Med 2026;26:37-44.