Background: Systemic venous congestion is associated with an increased risk of acute kidney injury (AKI) in critically ill patients. Venous Excess Ultrasound Score (VExUS) has been proposed as a noninvasive tool for assessing venous congestion based on ultrasonographic evaluation of the inferior vena cava, hepatic vein flow, portal vein pulsatility, and intrarenal Doppler flow. Objectives: The authors aimed to evaluate the association between the VExUS score and AKI in patients with acute heart failure (AHF). Methods: Prospective study including patients with AHF (acute de novo and decompensated chronic heart failure). VExUS was performed within the first 8 hours of hospital stay. Patients were classified by presence of severe congestion (VExUS 0-1/2-3). The primary objective was AKI, defined by Kidney Disease: Improving Global Outcomes criteria. Secondary objectives included the composite of AKI, cardiogenic shock, and all-cause mortality. Results: A total of 109 patients were included. After ultrasound assessment, 41 (37.2%) were categorized as having significant congestion (VExUS >1). VExUS >1 was more frequent in chronic HF and in patients with right ventricular involvement. At each increasing VExUS grade, a higher proportion developed AKI: VExUS = 0 (29.2%), VExUS = 1 (44%), VExUS = 2 (66.6%), and VExUS = 3 (60.7%) (P = 0.008). A significantly increased risk of AKI (HR: 2.65; 95% CI: 1.39-5.07; P = 0.003) was found in patients with VExUS >1. Adjusted logistic regression showed VExUS >1 as the strongest predictor (OR: 4.60; 95% CI: 1.47-16.0) of AKI during hospital stay. Conclusions: In AHF patients, the VExUS score is associated with AKI occurrence. Further studies are needed to clarify the role of VExUS assessment in HF.
