#3342 Venous excess ultrasound score and acute kidney injury in patients with decompensated heart failure

Abstract Background and Aims Systemic venous congestion is associated with an increased risk of acute kidney injury (AKI) in critically ill patients with cardiorenal syndrome. Venous excess ultrasound score (VExUS) has been proposed as a non-invasive tool to assess systemic venous congestion. This study aimed to evaluate the association between VExUS score, acute kidney injury (AKI) defined by KDIGO criteria, and renal outcome in patients with decompensated heart failure. Method This is a prospective, single-center study including 22 patients with a mean age of 78,18 ± 9,3 years, with chronic kidney disease (2 patients with stage 3a, 8 with stage 3b and 12 with stage 4). Patients were admitted to our hospital with decompensated heart failure and acute kidney injury, between April and September 2024 for 14,06 ± 9,5 days of hospital stay. VExUS and Focus Cardiac Ultrasound (FoCUS) regarding IVC ultrasound and right ventricular pathology were performed at the bedside during the first 24 hours of hospitalization and on discharge. Patients on renal replacement therapy, patients with portal hypertension, and transplant patients were excluded from the study. We recorded patient demographics, daily clinical characteristics, biochemistry blood test and urine analysis, hemodynamic factors, fluid balance, and diuretics during hospitalization. Echocardiographic variables including left ventricular ejection fraction (LVEF), left ventricular outflow tract (LVOT), and atrial and ventricular dimensions were also recorded. Results Seven patients had a VExUS Score of 0, three patients had a Score of 1, six patients had a Score of 2 and six patients had a Score of 3. Ten patients with a VExUS Score < 2 were classified as non-congested and 12 patients with a VExUS Score ≥ 2 as congested. Dyspnea was the main indication for hospitalization in 75% of patients in the VExUS ≥ 2 group. Congested patients had higher BMI, IVC and diuresis on the first day compared to non-congested. There was no significant correlation between the VExUS score at admission and the total dose of diuretics administered. Lower Tricuspid annular plane systolic excursion (TAPSE) was significantly associated with higher diuretic doses during the initial 24-hour period (P = 0.048). However, there was no correlation between TAPSE and AKI levels. Patients with VExUS Score >=2 at admission had a lower eGFR (26.7 ± 11.6) ml/min/1.73 m² compared to the VExUS Score <2 (35 ± 7.5) ml/min/1.73 m², a statistically significant difference (0.021). Patients with a VExUS score of 3 demonstrated higher serum creatinine levels at admission. Moreover, patients with a VExUS score exceeding 2, exhibited significantly elevated serum creatinine levels throughout their hospitalization and upon discharge, possibly due to the need for higher doses of diuretics or prolonged hospital stay, compared to those with a VExUS score of <2. All patients experienced a reduction in VExUS score by the time of discharge. There was no correlation between VExUS score and readmission at 3 months. Conclusion VExUS Score is a promising tool for the evaluation of systemic venous congestion. Further studies are needed to clarify the role of VExUS Score for treatment guidance and prediction of renal outcomes in the complex management of patients with chronic kidney disease and decompensated heart failure.