Diagnostic and Prognostic Value of the Venous Excess Ultrasound Grading System (Venous Excess Ultrasound (VExUS)): A Systematic Review and Meta-Analysis
Authors' conclusion
Results from this systematic review and meta-analysis suggest that VExUS has moderate to good accuracy to diagnose increased central venous pressure and right atrial pressure. In cardiac patients, higher VExUS grades are associated with AKI and mortality, but in critically ill patients, the association between VExUS grades and outcomes is less clear.
Study context
- Population
- Acute and critical care patients (cardiac and critically ill) assessed for venous congestion
- Participants
- 3,142 participants · 32 studies
- Comparison
- VExUS ≥2 vs lower grades
- Outcome
- Diagnostic accuracy for increased central venous and right atrial pressures; prognostic association with AKI and mortality
Methodological detailsdiagnostic and prognostic studies, GRADE certainty ratings, 6 diagnostic, 22 prognostic and 4 combined studies
- Diagnostic and prognostic studies
- GRADE certainty ratings
- 6 diagnostic, 22 prognostic and 4 combined studies
Pooled result
As reported in the abstract
AKI and mortality, cardiac patients
VExUS ≥2 vs VExUS <2Odds ratio (95% CI)
AKI; moderate certainty
4.44(2.34–8.43)
Mortality; low certainty
3.17(1.30–7.75)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| AKI, critically ill patients (subgroup)Very low certainty | 1.45 (0.70–2.99) | |
| Mortality, critically ill patients (subgroup)Low certainty | 1.25 (0.77–2.03) | |
| 0.20.5125Odds ratio (log scale) |
Diagnostic accuracy for increased central venous and right atrial pressures (no meta-analysis)
- Moderate to good diagnostic accuracy
- No meta-analysis could be performed
Per-patient analysis, VExUS 3
- VExUS 3 associated with mortality for all patients and with acute kidney injury (AKI) for cardiac patients
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Diagnostic and Prognostic Value of the Venous Excess Ultrasound Grading System (VExUS): A Systematic Review and Meta-Analysis. Crit Care Med. Published 9 June 2026. doi:10.
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