Acute renal failure is a frequent complication associated with significant morbidity and mortality in postoperative cardiac surgery. The VExUS (Venous Excess UltraSound grading system) score was created to qualitatively assess this venous congestion, based on ultrasound data from patients obtained post operatively in cardiac surgery. These data included: inferior vena cava diameter, Doppler flow of the suprahepatic veins, portal trunk and renal veins. This score is predictive of the onset of acute renal failure in the first 3 days after surgery. The VExUS score has not been validated in an external and prospective way in cardiac surgery.
Acute renal failure is a frequent complication associated with significant morbidity and mortality in postoperative cardiac surgery. The pathophysiology in this context is complex, poorly understood and the causes are multiple: underlying nephropathy, intra- or postoperative haemodynamic instability, the use of an extracorporeal circulation, inflammation, etc. One of the other possible etiologies is venous congestion. This may be due to volume overload and/or isolated global or right heart dysfunction. Early treatment could prevent the onset of ARF or reduce its consequences, hence the importance of being able to predict its onset. The VExUS (Venous Excess UltraSound grading system) score was created to qualitatively assess this venous congestion, based on ultrasound data from patients obtained post operatively in cardiac surgery. These data included: inferior vena cava diameter, Doppler flow of the suprahepatic veins, portal trunk and renal veins. This score is predictive of the onset of acute renal failure in the first 3 days after surgery. The VExUS score has not been validated in an external and prospective way in cardiac surgery.
Study Type
OBSERVATIONAL
Enrollment
119
University Hospital Grenoble
Grenoble, France
RECRUITINGAssociation between the change in ultrasound data collected in the VExUS score and postoperative acute renal failure (defined by a creatininemia increase by 26.5 µmol/L in 48 hours).
correlation between operator in term of VExUS staging (VExUS score will be assessed at day 1, 2 and 3 after the surgery, in intensive care unit.
Time frame: From date of randomization until date of post-operative acute renal failure (detected by daily creatininemia), assessed up to a variable period of time estimated to 2 weeks.
Association between the change in ultrasound data collected in the VExUS score and postoperative acute renal failure.
Specificity of the VExUS score to predict an acute kidney failure will be evaluated
Time frame: From date of randomization until date of post-operative acute renal failure (detected by daily creatininemia), assessed up to a variable period of time estimated to 2 weeks
Correlation between the VExUS score and a postoperative acute renal failure
Use of a multivariable COX regression to evaluate the correlation between the VExUS score measured at day 1, 2 and 3 and a post-operative acute renal failure during the stay in intensive care unit
Time frame: 3 days
Diagnostic performances of the VExUS Score for postoperative acute renal failure
Sensitivity, NPV, PPV
Time frame: 3 days
Correlation between central venous pressure (CVP) and postoperative acute renal failure. If a statistical association is present, diagnostic performance (Sensitivity, Specificity, NPV, PPV) of the value
Central venous pressure (CVP). The values will be taken during the ultrasound scans at Day 0, Day 1 and Day 2. The units of pressure are mmHg. A value greater than 12mmHg will be considered high, a lower value as not high. The CVP is measured by a central venous line.
Time frame: 3 days
Correlation between daily fluid balance and postoperative acute renal failure. If a statistical association is present, diagnostic performance (Sensitivity, Specificity, NPV, PPV) of the value
Water balance: 24-hour input-output balance, in millilitres, collected daily. Values measured at Day 0, Day 1, Day 2
Time frame: 3 days
Correlation between daily fluid balance and postoperative acute renal failure. If a statistical association is present, diagnostic performance (Sensitivity, Specificity, NPV, PPV) of the value
Water balance: including the weight in Kg compared to the reference weight established during the anaesthetic consultation. Values measured at Day 0, Day 1, Day 2
Time frame: 3 days
Correlation between an isolated component of the VExUS score, echocardiography and postoperative acute renal failure. If a statistical association is present, diagnostic performance (Sensitivity, Specificity, NPV, PPV) of the value
An isolated component of the VExUS score that is measured at D0; D1; D2 by ultrasound 1. Inferior vena cava diameter 2. Doppler profile of the suprahepatic vein 3. Doppler profile of portal vein 4. Renal vein Doppler profile
Time frame: 3 days
Correlation between an echocardiographic abnormality and postoperative acute renal failure. If a statistical association is present, diagnostic performance (Sensitivity, Specificity, NPV, PPV) of the value.
Ultrasound assessment of the left and right heart: Visual LVEF, sub-aortic LTI, Mitral Doppler (E wave, A wave, E/A ratio, deceleration time), LV/VD ratio (less than or greater than 0.6); TAPSE (unit: mm); S wave (unit: cm/seconds); LTI flow (unit: m/seconds); diameter (unit: mm) and ICV compliance. Values also taken at D0, D1 and D2.
Time frame: 3 days
Correlation between VExUS score and the use of extra renal replacement therapy
Use of extra renal replacement therapy: based on dialysis prescriptions, binary value (yes/no) regardless of the method used (CVVHF, CVVHDF, CVVHD)
Time frame: From randomization until date of postoperative need of extra renal replacement therapy, assessed up to a variable period of time estimated to 2 weeks.
Correlation between VExUS score and length of stay
Length of stay in days: in intensive care, cardiac surgery and rehabilitation. Determined thanks to medical records.
Time frame: From randomization until date of discharge, assessed up to a variable period of time estimated to 2 weeks.
Correlation between VExUS score and 1-month mortality
Mortality: binary (yes/no) at 1 month. The data will be collected by phone call to the patient or a relative, or by consulting the medical record.
Time frame: 1 month after admission in intensive care
Correlation between renal arterial resistance index and postoperative acute renal failure. If a statistical association is present, diagnostic performance (Sensitivity, Specificity, NPV, PPV)
Renal arterial resistance index are measured at D0; D1; D2 during the ultrasound scans.
Time frame: 3 days
Correlation between renal venous impedance index and postoperative acute renal failure. If a statistical association is present, diagnostic performance (Sensitivity, Specificity, NPV, PPV)
Veinous impedance index are measured at D0; D1; D2 during the ultrasound scans.
Time frame: 3 days
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