Written by Samuel Rouleau
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A small prospective study found that a high VExUS score was associated with 30-day mortality in patients with CHF who presented to the ED. This study must be interpreted with caution.
VExUS vexes?
This study included 47 patients with a diagnosis of CHF who presented to the ED. Two trained physician ultrasonographers performed the VExUS protocol and stratified the patients into three separate groups based on a VExUS score of 1, 2, or 3. A VExUS score of 3 was associated with higher-rates of 30-day mortality, OR 15.92, 95%CI 1.18–214.47 (note the crazy width of the confidence interval). Interestingly, a portal vein diameter > 10 mm was found to be the optimal cut-off for predicting mortality.
Designing ultrasound studies is tough, and – as an ultrasound aficionado – I applaud the effort to continue clinical investigation in this realm. However, I have many misgivings about this study, so in true Sam fashion, they are in bullet form below:
- The study is not appropriately powered for its conclusions.
- Only age and gender were controlled for. There was no control for comorbid conditions or consideration of concurrent conditions that could directly impact a VExUS score (like severe tricuspid regurgitation).
- Those with a VExUS score of 3 tended to have lower systolic blood pressure, which indicates the potential for confounders (i.e. VExUS scores of 3 had more severe cardiac disease at baseline).
- The serum markers of severity of disease/congestion (lactate, troponin, BNP, LFTs, Cr) were most elevated in those with VExUS score 2, which again indicates that there are either multiple unaccounted confounders (which the authors mention) or errors in group discrimination.
- The actual 30-day mortality rates between the groups with VExUS score 2 and 3 were the same.
How does this change my practice?
This study will not change my practice. On the extreme end of high scores, VExUS can be helpful, but it rarely gives me new information. I ultrasound the IJ as part of a volume assessment because it is impacted to a lesser degree by intra-abdominal processes that impact IVC assessment.
Source
Effectiveness of VExUS scores for predicting mortality among patients followed up in the emergency department due to congestive heart failure: a prospective cross-sectional study. BMC Emerg Med. 2025 Jul 1;25(1):101. doi: 10.1186/s12873-025-01271-3. PMID: 40597631
