[Exploratory evaluation of handheld simplified venous excess ultrasound grades for bedside assessment of venous congestion in intensive care unit patients].
To explore the value of handheld simplified venous excess ultrasound (VExUS) grades in bedside venous congestion assessment in general intensive care unit (ICU) patients and to examine its associations with disease severity scores and fluid overload indicators.
This study was a secondary analysis based on data from a single-center prospective observational ICU cohort database. The data were derived from the existing ICU cohort database of the ICU of China-Japan Friendship Hospital. The original study included critically ill patients admitted to the ICU of China-Japan Friendship Hospital from June 14 to August 21 in 2024, all of whom underwent handheld ultrasound and conventional ultrasound VExUS-related examinations. Demographic data, severity of illness scores, laboratory indicators, fluid balance, and supportive treatment information were also collected simultaneously. The main ultrasound variables included the handheld simplified VExUS grading and its key component parameters (inferior vena cava short-to-long axis ratio, hepatic vein S/D ratio, and portal vein pulsatility fraction). Descriptive analysis was used to evaluate the overall distribution of handheld simplified VExUS indicators. Spearman rank correlation analysis was employed to evaluate the relationship between the handheld simplified VExUS grading and its key component parameters with the Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and fluid balance within 24 hours after ICU admission. The differences in clinical indicators among patients with different handheld simplified VExUS grading were compared, and the primary analysis of continuous ultrasound parameters employed the post-hoc mean values of independent measurements taken by two operators, and sensitivity analysis was conducted separately using the original measurements of the two operators. Multiple comparison correction for the primary correlation analysis was performed using the Benjamini-Hochberg false discovery rate (FDR).
The original study included a total of 80 critically ill patients. After excluding 2 minor patients from this study, a total of 78 adult patients were finally included in the overall analysis. The overall disease severity of the 78 adult ICU patients was moderate, with an APACHE II score of 20.0 (15.3, 25.0) and a SOFA score of 7.0 (4.0, 11.0). The handheld simplified VExUS grading was mainly at grades 0 and 1, with 48 cases (62%) at grade 0, 26 cases (33%) at grade 1, and 4 cases (5%) at grade 2. The average values of the inferior vena cava short-to-long axis ratio, hepatic vein S/D ratio, and portal vein pulsatility fraction were 0.763 (0.668, 0.809), 1.358 (1.252, 1.571), and 0.243 (0.180, 0.303), respectively. In the primary correlation analyses, the mean inferior vena cava short-to-long axis ratio was positively correlated with APACHE II score and SOFA score (r values were 0.302 and 0.252, with unadjusted P values of 0.007 and 0.026, respectively), while portal vein pulsatility fraction was positively correlated with 24-hour fluid balance (r=0.290, unadjusted P value was 0.010). However, no significant correlation was observed between the handheld simplified VExUS grading and either the severity of illness scores or the volume overload indices. After Benjamini-Hochberg FDR correction, the correlation between the mean inferior vena cava short-to-long axis ratio and both the APACHE II score and the SOFA score did not reach statistical significance (FDR-corrected P values were 0.080 and 0.139, respectively). Similarly, the correlation between the mean portal vein pulsatility fraction and 24-hour fluid balance also failed to maintain statistical significance (FDR-corrected P value was 0.080). After stratification by the simplified handheld VExUS grading, there were no statistically significant differences in APACHE II score, SOFA score, NT-proBNP level, and 24-hour fluid balance among patients with different grades (all P>0.05). A sensitivity analysis was conducted using the original measurements from two operators on the core pairs with original correlation signals in the main analysis, and the results were largely consistent with the main analysis. However, the previously observed associations did not remain statistically significant after Benjamini-Hochberg FDR correction.
In general ICU patients, the handheld simplified VExUS grade showed limited associations with disease severity scores and volume overload indicators. Some key component parameters showed exploratory signals related to disease severity or fluid balance in the original correlation analysis, but did not maintain statistical significance after FDR correction.
This study was a secondary analysis based on data from a single-center prospective observational ICU cohort database. The data were derived from the existing ICU cohort database of the ICU of China-Japan Friendship Hospital. The original study included critically ill patients admitted to the ICU of China-Japan Friendship Hospital from June 14 to August 21 in 2024, all of whom underwent handheld ultrasound and conventional ultrasound VExUS-related examinations. Demographic data, severity of illness scores, laboratory indicators, fluid balance, and supportive treatment information were also collected simultaneously. The main ultrasound variables included the handheld simplified VExUS grading and its key component parameters (inferior vena cava short-to-long axis ratio, hepatic vein S/D ratio, and portal vein pulsatility fraction). Descriptive analysis was used to evaluate the overall distribution of handheld simplified VExUS indicators. Spearman rank correlation analysis was employed to evaluate the relationship between the handheld simplified VExUS grading and its key component parameters with the Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and fluid balance within 24 hours after ICU admission. The differences in clinical indicators among patients with different handheld simplified VExUS grading were compared, and the primary analysis of continuous ultrasound parameters employed the post-hoc mean values of independent measurements taken by two operators, and sensitivity analysis was conducted separately using the original measurements of the two operators. Multiple comparison correction for the primary correlation analysis was performed using the Benjamini-Hochberg false discovery rate (FDR).
The original study included a total of 80 critically ill patients. After excluding 2 minor patients from this study, a total of 78 adult patients were finally included in the overall analysis. The overall disease severity of the 78 adult ICU patients was moderate, with an APACHE II score of 20.0 (15.3, 25.0) and a SOFA score of 7.0 (4.0, 11.0). The handheld simplified VExUS grading was mainly at grades 0 and 1, with 48 cases (62%) at grade 0, 26 cases (33%) at grade 1, and 4 cases (5%) at grade 2. The average values of the inferior vena cava short-to-long axis ratio, hepatic vein S/D ratio, and portal vein pulsatility fraction were 0.763 (0.668, 0.809), 1.358 (1.252, 1.571), and 0.243 (0.180, 0.303), respectively. In the primary correlation analyses, the mean inferior vena cava short-to-long axis ratio was positively correlated with APACHE II score and SOFA score (r values were 0.302 and 0.252, with unadjusted P values of 0.007 and 0.026, respectively), while portal vein pulsatility fraction was positively correlated with 24-hour fluid balance (r=0.290, unadjusted P value was 0.010). However, no significant correlation was observed between the handheld simplified VExUS grading and either the severity of illness scores or the volume overload indices. After Benjamini-Hochberg FDR correction, the correlation between the mean inferior vena cava short-to-long axis ratio and both the APACHE II score and the SOFA score did not reach statistical significance (FDR-corrected P values were 0.080 and 0.139, respectively). Similarly, the correlation between the mean portal vein pulsatility fraction and 24-hour fluid balance also failed to maintain statistical significance (FDR-corrected P value was 0.080). After stratification by the simplified handheld VExUS grading, there were no statistically significant differences in APACHE II score, SOFA score, NT-proBNP level, and 24-hour fluid balance among patients with different grades (all P>0.05). A sensitivity analysis was conducted using the original measurements from two operators on the core pairs with original correlation signals in the main analysis, and the results were largely consistent with the main analysis. However, the previously observed associations did not remain statistically significant after Benjamini-Hochberg FDR correction.
In general ICU patients, the handheld simplified VExUS grade showed limited associations with disease severity scores and volume overload indicators. Some key component parameters showed exploratory signals related to disease severity or fluid balance in the original correlation analysis, but did not maintain statistical significance after FDR correction.