Acute renal failure after cardiac surgery is a common postoperative complication, affecting approximately 20% of patients. It is associated with an increase in short-term mortality and an increase in hospital stay; but is also associated with an increase in long-term mortality of up to 30% at 5 years, even if renal function recovers upon discharge. Its origin is multifactorial: intraoperative hypoperfusion, including hemodynamic variations related to extracorporeal circulation or bleeding, postoperative hypoperfusion related to cardiogenic or vasoplegic shock, ischemia-reperfusion phenomena leading to cell lysis or inflammation at the tubular level, inflammation and oxidative stress related to extracorporeal circulation, and hemolysis are the main causes. Hydro-sodium overload and associated venous congestion is also one of the etiologies of acute renal failure in post-operative cardiac surgery and is associated with increased mortality. The proposed pathophysiological mechanism is based on the decrease in renal tissue perfusion pressure due to the increase in venous pressure. In the extreme, the increase in pressure in the renal capsule could lead to true renal ischemia due to engorgement. This renal congestion can be diagnosed based on clinical signs, biological signs (such as NT-pro-BNP) or by monitoring by central venous pressure (CVP). However, these statistical tools have low diagnostic performance, and new tools based on ultrasound and Doppler are being developed. Indeed, alterations in venous flow in the renal, suprahepatic and portal veins, reflecting the increase in pressures there, are associated with the onset of acute renal failure in post-operative cardiac surgery.
More recently, a retrospective postoperative cardiac surgery study assessed venous congestion using the VEXUS (Venous Excess UltraSound) composite score. This score explores the diameter of the inferior vena cava (IVC) and venous flows in the hepatic, portal, and renal veins, and is associated with acute renal failure. Its diagnostic performance is based on the joint analysis of all Doppler flows and offers better diagnostic performance than isolated CVP measurement. The primary objective of this study is to prospectively investigate this ultrasound score and its association with the development of acute renal failure postoperatively after cardiac surgery. Due to the morbidity and mortality associated with renal failure described above, a secondary objective of the study is to investigate the association between the VEXUS score and the development of chronic renal failure.
Study Type
OBSERVATIONAL
The aim is to prospectively evaluate the association between the ultrasound score (VEXUS) and the occurrence of acute renal failure post-operatively following cardiac surgery. The VEXUS (Venous Excess UltraSound) score is an ultrasound tool used in medicine to assess systemic venous congestion, i.e. excess pressure in the venous system linked to volume overload or right heart failure. The VEXUS score relies on ultrasound of the inferior vena cava (IVC) to assess the extent of congestion in this vein. score 0 : Normal IVC + Normal Dopplers; score 1 : Dilated IVC + altered hepatic venous Doppler, but normal portal vein; score 2 : Portal vein shows significant pulsatility; score 3 : Severe pulsatility + marked alteration of hepatic and portal flow
University Rouen Hospital
Rouen, France
To study the association between the VEXUS score and the occurrence of acute renal failure post-operatively after cardiac surgery.
Onset of acute renal failure characterized by a score greater than or equal to KDIGO 1. (KDIGO 1 : Creatinine increased by \>26.5 µmol/L or 1.5-1.9 times the reference value, Diuresis \<0.5 mL/kg/h for 6-12 hours; KDIGO 2 : Creatinine x 2-2.9 compared to the reference value, Diuresis \< 0.5/mL/kg/h for \> 12h; KDIGO 3 : Creatinine x 3 or increase of \>353.6 µmol/L compared to the reference value Use of extra-renal replacement therapy, Diuresis \< 0.3 mL/kg/h for \> 24 hours or anuria for \> 12 hours.)
Time frame: visit Hour no. 02, i.e. 2 hours after the intervention; visit Day 1 and visit Day 2
Study of the correlation or association between the VEXUS score and - the value of Central Venous Pressure (CVP)
Studying the correlation between the VEXUS score and PVC allows us to validate or not the VEXUS as a reliable non-invasive tool for assessing venous congestion.
Time frame: visit Hour no. 02, i.e. 2 hours after the intervention; visit Day 1 and visit Day 2
Study of the correlation or association between the VEXUS score and the NT-pro-BNP level
Studying the relationship between VEXUS score and NT-proBNP (biomarker of cardiac volume overload) helps determine whether venous ultrasound can be a reliable substitute for the biomarker to detect volume congestion, especially in critically ill patients.
Time frame: visit Hour no. 02, i.e. 2 hours after the intervention; visit Day 1 and visit Day 2
Study of the correlation or association between the VEXUS score and the Hydro-sodium balance in intensive care
to determine whether the VEXUS score, which reflects venous congestion assessed by ultrasound, is correlated or associated with the hydro-sodium balance, i.e. the quantity of liquid and sodium retained or eliminated by a patient in intensive care
Time frame: visit Hour no. 02, i.e. 2 hours after the intervention; visit Day 1 and visit Day 2
Study of the correlation or association between the VEXUS score and The time of the first dose of diuretics administered
Determine whether a high VEXUS score is associated with early administration of diuretics, which would allow us to Validate VEXUS as a therapeutic decision-making tool
Time frame: visit Hour no. 02, i.e. 2 hours after the intervention; visit Day 1 and visit Day 2
Study of the correlation or association between the VEXUS score and The onset of chronic renal failure (assessed at 3 months)
To determine whether the VEXUS score, used from hospitalization, can predict chronic renal evolution at 3 months.
Time frame: visit month 3
Study of the correlation or association between the VEXUS score and The length of hospitalization
To determine whether the VEXUS score, measured at the beginning or during hospitalization, is correlated or associated with the total length of hospital stay (unity : day)
Time frame: Visit 12 months
Study of the correlation or association between the VEXUS score and The onset of chronic renal failure (assessed at 12 months)
To determine whether the VEXUS score, used from hospitalization, can predict chronic renal evolution at 12 months.
Time frame: visit month 12
Study of the correlation or association between the VEXUS score and The mortality (assessed at 3 months)
Validating VEXUS as a prognostic marker with mortality at 3 months.
Time frame: visit month 3
Study of the correlation or association between the VEXUS score and The mortality (assessed at 12 months)
Validating VEXUS as a prognostic marker with mortality at 12 months.
Time frame: visit month 12
Study of the correlation or association between the VEXUS score and The quality of life (assessed at 3 months)
Validate VEXUS as a prognostic marker of 3-month mortality with EQ-5D-5L quiz. The EQ-5D-5L is a standardized questionnaire designed to measure health-related quality of life (HRQoL). Five levels are assessed: Mobility; Self-care; Usual activities; Pain/discomfort and Five levels are assessed: Anxiety/depression. Each dimension has 5 severity levels, rated from 1 to 5. (level 1 : No problem; level 2 : Mild problem; level 3 : Moderate problem; level 4 : Severe problem; level 5 : Extreme disability / very severe problem). The patient's overall health status is determined on a scale of 0 to 100 (0 = worst imaginable health status; 100 = best imaginable health status)
Time frame: visit month 3
Study of the correlation or association between the VEXUS score and The quality of life (assessed at 12 months)
Validate VEXUS as a prognostic marker of 12-month mortality with EQ-5D-5L quiz. The EQ-5D-5L is a standardized questionnaire designed to measure health-related quality of life (HRQoL). Five levels are assessed: Mobility; Self-care; Usual activities; Pain/discomfort and Five levels are assessed: Anxiety/depression. Each dimension has 5 severity levels, rated from 1 to 5. (level 1 : No problem; level 2 : Mild problem; level 3 : Moderate problem; level 4 : Severe problem; level 5 : Extreme disability / very severe problem). The patient's overall health status is determined on a scale of 0 to 100 (0 = worst imaginable health status; 100 = best imaginable health status)
Time frame: visit month 12
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.