Venous congestion patterns assessed by doppler ultrasonography and their association with major adverse kidney events, organ dysfunction and fluid responsiveness in patients with sepsis

Abstract Background Venous congestion is increasingly recognized as a major contributor to organ dysfunction in sepsis. Bedside Doppler ultrasonography of the hepatic vein (HV), portal vein (PV) and intrarenal veins (IRV) offers a noninvasive method for assessing venous hemodynamics, yet its association with prognostic scores and fluid responsiveness in critically ill septic patients remains incompletely defined. Objectives To evaluate HV, PV and IRV Doppler patterns in critically ill patients with sepsis and determine their association with fluid responsiveness, severity of illness scores, major adverse kidney events within 28 days (MAKE-28), and other sepsis-related morbidities. Methods In this prospective observational cohort study, 110 adult patients with sepsis admitted to the intensive care units of Cairo University Hospitals between March 2023 and November 2024 were enrolled. All patients underwent standardized clinical assessment, calculation of SOFA, APACHE II, and MODS scores, laboratory investigations, transthoracic echocardiography for fluid responsiveness, and venous Doppler ultrasonography of the HV, PV and IRV within 24 hours of ICU admission. Patients were followed up for MAKE-28, organ dysfunction and need for organ support. Results Abnormal HV, PV and IRV Doppler patterns were significantly associated with higher SOFA and APACHE II scores and a higher incidence of acute kidney injury and hepatic impairment. Fluid-responsive patients demonstrated significantly lower SOFA, APACHE II and MODS scores, and lower rates of disturbed consciousness and shock state. No significant association was observed between venous Doppler abnormalities and mortality. Conclusions In septic ICU patients, abnormal hepatic, portal and intrarenal venous Doppler findings are closely linked to disease severity and adverse renal outcomes. Venous Doppler ultrasonography represents a valuable bedside tool for risk stratification and may support individualized hemodynamic and fluid management strategies in sepsis.