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Paper title Role of Femoral Vein Doppler in the Prediction of Acute Kidney Injury in Patients with Complicated Intra-abdominal Sepsis
Paper code A01
Authors
  1. Puneet Khanna All India Institute of Medical Sciences, New Delhi Speaker
  2. Bhawna Kayarat All India Institute Of Medical Sciences, New Delhi
Form of presentation Oral abstract presentation
Topics
  • Novel scientific information
Abstract text Background: Excessive fluid administration is a major contributor to venous congestion, which in turn increases the risk of acute kidney injury (AKI)1. Detecting venous congestion early in critically ill patients, especially those with complicated intra-abdominal infections (cIAI), is crucial to guide fluid management. However, transthoracic echocardiography and venous excess ultrasound (VExUS) may be difficult to perform postoperatively due to limited acoustic windows. Femoral vein Doppler (FVD) is a feasible bedside alternative and correlates well with VExUS in assessing systemic congestion2-3. We hypothesized that abnormal FVD patterns can predict the development of AKI in cIAI patients.

Message: This prospective observational study enrolled 98 adult cIAI patients admitted to the ICU. Patients with poor ultrasound windows, liver disease, respiratory distress, or deep vein thrombosis were excluded. FVD was assessed within 24 hours of ICU admission. Congestion was defined by specific waveform abnormalities (pulsatile or reversed flow). VExUS was performed when feasible. AKI was defined using KDIGO criteria over 7 days.
Out of 98 patients, 52 (53%) developed AKI. Abnormal FVD was detected in 36 (36.7%) patients, with 27 showing pulsatile flow and 9 showing flow reversal. Abnormal FVD had a sensitivity of 57.7%, specificity of 86.9%, positive predictive value of 83.3%, and negative predictive value of 64.5% for predicting AKI. The area under the curve (AUC) was 0.723. Abnormal FVD was strongly associated with AKI with an odds ratio of 9.09 (p < 0.01). VExUS was feasible in only 60% of patients.

Impact on Patient Care: FVD is a practical and reliable bedside tool for early identification of AKI risk in cIAI patients. Given its high specificity, strong association with AKI, and better feasibility compared to VExUS, incorporating FVD into routine ICU assessments may improve fluid management and outcomes in critically ill surgical patients.