{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:07:40Z","timestamp":1792789660997,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Physician Services Incorporated (PSI)","award":["R22:32"],"award-info":[{"award-number":["R22:32"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Aim: Both the arterial and venous systems independently predict mortality in septic shock, yet no bedside tools are able to integrate their assessment. Risk stratification becomes challenging when arterial parameters suggest favourable outcomes while venous parameters indicate poor prognosis, or vice versa. To address this gap, we developed the VTI-VeXUS index and conducted this proof-of-concept study to test its association with mortality. Methods: We conducted a prospective cohort study in two ICUs, enrolling adult patients with septic shock. We calculated the VTI-VeXUS index (VTI\/[VeXUS+1]) from ultrasound measurements obtained within 24 h of ICU admission and stratified patients as having a high or low VTI-VeXUS index based on a cutoff of 11. We evaluated the primary outcome of mortality at 30 days using survival analysis. Results: We enrolled 62 patients. Patients with a low VTI-VeXUS index had higher rates of left ventricular dysfunction (32.3% vs. 3.2%, p = 0.006), right ventricular dysfunction (35.5% vs. 0.0%, p &lt; 0.001), lower stroke volume (54.0 mL vs. 62.0 mL, p = 0.005), and increased 30-day mortality (adjusted HR: 3.86, 95% CI 1.23 to 12.14). Conclusions: In this exploratory proof-of-concept study, a low VTI-VeXUS index was associated with ventricular dysfunction and increased mortality. While limited by small sample size and univariate analysis, these findings suggest this novel integrated metric warrants validation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/jcm14165774","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T10:33:42Z","timestamp":1755254022000},"page":"5774","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The VTI-VeXUS Index in Septic Shock: An Exploratory Proof-of-Concept Observational Study of a Novel Hemodynamic Parameter"],"prefix":"10.3390","volume":"14","author":[{"given":"Ross","family":"Prager","sequence":"first","affiliation":[{"name":"Division of Critical Care, Western University, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Pupulin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Western University, London, ON N6A 3K7l, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hawwa","family":"Chakera","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Western University, London, ON N6A 5C1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhidita","family":"Saha","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Western University, London, ON N6A 5C1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1054-3749","authenticated-orcid":false,"given":"Nicolas","family":"Orozco","sequence":"additional","affiliation":[{"name":"Centro de Investigaciones Cl\u00ednicas, Fundaci\u00f3n Valle de Lili, Cali 760001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3654-1146","authenticated-orcid":false,"given":"Jon-Emile","family":"Kenny","sequence":"additional","affiliation":[{"name":"Health Sciences North Research Institute, Greater Sudbury, ON P3E 2H3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-9212","authenticated-orcid":false,"given":"Philippe","family":"Rola","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Santa Cabrini Hospital, CEMTL, Montr\u00e9al, QC H1T 1P7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle Yee Suet","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Western University, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marat","family":"Slessarev","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Western University, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberley","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9600-3403","authenticated-orcid":false,"given":"Sarah","family":"Neil-Sztramko","sequence":"additional","affiliation":[{"name":"McMaster Department of Health Research Methods, Evidence & Impact, National Collaborating Centre for Methods and Tools, Hamilton, ON L8S 4L8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bram","family":"Rochwerg","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"},{"name":"McMaster Department of Health Research Methods, Evidence & Impact, National Collaborating Centre for Methods and Tools, Hamilton, ON L8S 4L8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Basmaji","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Western University, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1177\/0885066618784861","article-title":"Fluid Management in Sepsis","volume":"34","author":"Brown","year":"2019","journal-title":"J. Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1056\/NEJMoa1500896","article-title":"Trial of early, goal-directed resuscitation for septic shock","volume":"372","author":"Mouncey","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1056\/NEJMoa1401602","article-title":"A randomized trial of protocol-based care for early septic shock","volume":"370","author":"Yealy","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/EJA.0000000000001508","article-title":"Vasopressor effects on venous return in septic patients: A review","volume":"38","author":"Feldheiser","year":"2021","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e009961","DOI":"10.1161\/JAHA.118.009961","article-title":"Alterations in Portal Vein Flow and Intrarenal Venous Flow Are Associated With Acute Kidney Injury After Cardiac Surgery: A Prospective Observational Cohort Study","volume":"7","author":"Benkreira","year":"2018","journal-title":"J. Am. Hear Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13089-021-00232-8","article-title":"Clinical applications of the venous excess ultrasound (VExUS) score: Conceptual review and case series","volume":"13","author":"Rola","year":"2021","journal-title":"Ultrasound J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13089-020-00163-w","article-title":"Quantifying systemic congestion with Point-Of-Care ultrasound: Development of the venous excess ultrasound grading system","volume":"12","author":"Rola","year":"2020","journal-title":"Ultrasound J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1007\/s12630-024-02717-1","article-title":"Venous congestion in septic shock quantified with point-of-care ultrasound: A pilot prospective multicentre cohort study","volume":"71","author":"Prager","year":"2024","journal-title":"J. Can. Anesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e074843","DOI":"10.1136\/bmjopen-2023-074843","article-title":"Doppler identified venous congestion in septic shock: Protocol for an international, multi-centre prospective cohort study (Andromeda-VEXUS)","volume":"13","author":"Prager","year":"2023","journal-title":"BMJ Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1186\/s13054-020-03330-6","article-title":"The use of venous Doppler to predict adverse kidney events in a general ICU cohort","volume":"24","author":"Spiegel","year":"2020","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Vellinga, N.A., Ince, C., and Boerma, E.C. (2013). Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: A hypothesis generating post hoc analysis. BMC Anesthesiol., 13.","DOI":"10.1186\/1471-2253-13-17"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Guarino, M., Perna, B., Cesaro, A.E., Maritati, M., Spampinato, M.D., Contini, C., and De Giorgio, R. (2023). 2023 update on sepsis and septic shock in adult patients: Management in the emergency department. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093188"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.amjcard.2023.07.007","article-title":"Hemodynamic Evaluation of Right-Sided Congestion with Doppler Ultrasonography in Pulmonary Hypertension","volume":"203","author":"Cruz","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.ekir.2023.12.018","article-title":"Prospective study of ultrasound markers of organ congestion in critically ill patients with acute kidney injury","volume":"9","author":"Galarza","year":"2024","journal-title":"Kidney Int. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"356","DOI":"10.11152\/mu-4418","article-title":"The VExUS score and mortality in patients with Acute Kidney Injury: Findings from a multidisciplinary prospective study","volume":"26","author":"Aslaner","year":"2024","journal-title":"Med. Ultrason."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ejim.2019.11.019","article-title":"Impact of left ventricular dysfunction and fluid balance on the outcomes of patients with sepsis","volume":"74","author":"Hong","year":"2020","journal-title":"Eur. J. Intern. Med."},{"key":"ref_18","first-page":"15","article-title":"Diastolic Dysfunction in Sepsis and Septic Shock: Which Parameters are Most Predictive?","volume":"10","author":"Saleh","year":"2023","journal-title":"Egypt. J. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1093\/eurheartj\/ehr351","article-title":"Diastolic dysfunction and mortality in severe sepsis and septic shock","volume":"33","author":"Landesberg","year":"2012","journal-title":"Eur. Hear J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kenny, J.S.M., Prager, R., Rola, P., Haycock, K., Basmaji, J., and Hern\u00e1nDez, G. (2023). Unifying Fluid Responsiveness and Tolerance With Physiology: A Dynamic Interpretation of the Diamond-Forrester Classification. Crit. Care Explor., 5, (In English).","DOI":"10.1097\/CCE.0000000000001022"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.healun.2015.06.009","article-title":"Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation","volume":"35","author":"Kang","year":"2016","journal-title":"J. Hear Lung Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e009085","DOI":"10.1161\/CIRCHEARTFAILURE.121.009085","article-title":"Association of pulmonary artery pulsatility index with adverse cardiovascular events across a hospital-based sample","volume":"15","author":"Zern","year":"2022","journal-title":"Circ. Hear Fail."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.cjco.2023.04.005","article-title":"Association between the pulmonary artery pulsatility index and prognosis in pulmonary arterial hypertension: A multicentre study","volume":"5","author":"Ostad","year":"2023","journal-title":"CJC Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1177\/08850666231224396","article-title":"Simultaneous venous-arterial Doppler ultrasound during early fluid resuscitation to characterize a novel Doppler starling curve: A prospective observational pilot study","volume":"39","author":"Kenny","year":"2024","journal-title":"J. Intensive Care Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5774\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:28:10Z","timestamp":1760034490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,15]]},"references-count":24,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165774"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165774","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,15]]}}}