Association between venous excess ultrasound score and major adverse kidney events at 30 days in critically ill elderly patients: a multicenter prospective cohort study.

BACKGROUND: Venous congestion is common in critically ill patients and is associated with adverse outcomes, including acute kidney injury (AKI). Elderly patients may be especially susceptible to congestion-related organ dysfunction due to reduced cardiovascular compliance and limited cardiorenal reserve. The venous excess ultrasound (VExUS) score provides a noninvasive bedside assessment of systemic venous congestion. However, its prognostic value in critically ill elderly patients remains unclear. We therefore conducted this multicenter prospective cohort study to evaluate the prevalence of venous congestion assessed by VExUS and its association with adverse kidney events in this population. METHODS: This multicenter prospective cohort study was conducted in the intensive care units (ICUs) of three tertiary hospitals in China. Critically ill patients aged 65 years or older who underwent VExUS assessment within 24 h of ICU admission were eligible for inclusion. Patients were classified into a venous congestion (VExUS ≥2) and a non-congestion (VExUS <2) group. The primary outcome was major adverse kidney events at 30 days (MAKE-30), defined as a composite of serum creatinine reaching ≥200% of the baseline value, initiation of renal replacement therapy (RRT), or death within 30 days of ICU admission. Associations between venous congestion and clinical outcomes were evaluated using logistic regression and Cox proportional hazards regression models. Kaplan-Meier curves were generated for MAKE-30. RESULTS: One hundred five patients were included in the final analysis, with a median age of 80 years [73-86] and a high prevalence of cardiovascular comorbidities. VExUS ≥2 was observed in 21 patients (20.0%) and was associated with MAKE-30 (adjusted odds ratio [aOR] 5.68, 95% confidence interval [CI] 1.59-27.77; p = 0.014). Kaplan-Meier analysis demonstrated a higher cumulative incidence of MAKE-30 among patients with VExUS ≥2 (p < 0.001, log-rank test). CONCLUSION: Venous congestion is not uncommon within the first 24 h of ICU admission in critically ill elderly patients. VExUS is associated with adverse kidney events in elderly patients and represents a promising bedside tool for the assessment of venous congestion. CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/, identifier, ChiCTR2200066987.