Inferior Vena Cava-Aortic Ratio Measurement as A Promising Modality in Assessing Intravascular Volume in Sepsis-Associated Acute Kidney Injury Among Children in Limited Resources

Abstract

Abstract Introduction: Hemodynamic monitoring is crucial for the comprehensive management of children with sepsis, particularly those involving the kidneys. Sepsis-associated acute kidney injury (S-AKI) is closely linked to patient outcomes, including an increased risk of end-stage kidney disorders, cardiovascular disorders, and death. In developing countries, due to the limited availability of USCOM, an invasive method such as central venous pressure (CVP) monitoring is needed to monitor intravascular volume, which has a high potential for complications and is costly. We conducted research to determine intravascular volume based on ultrasound examination in S-AKI patients. Methods A prospective cohort study was conducted between December 2023 and March 2024 in the Pediatric Intensive Care Unit (PICU) at Hasan Sadikin General Hospital. We divided the patients into two groups: those with sepsis and those with sepsis-associated acute kidney injury. The intravascular volume was measured by the IVC/Ao (Inferior vena cava/Abdominal aorta) ratio using two-dimensional ultrasonography and USCOM before and 24 hours after fluid treatment. The results were then analyzed using SPSS 25, with a significance level of p < 0.05. Results A total of 36 pediatric patients (aged between 1 month and 18 years) with sepsis were included in this study. The IVC/Ao ratio before and after the fluid intervention demonstrated significant differences between the two groups (p < 0.001). USCOM's CI before and after the intervention also showed significant differences between the two groups (p < 0.001). Patients with S-AKI exhibited a poor hemodynamic response in the IVC/Ao ratio two-dimensional ultrasonography and USCOM examination. Conclusion The IVC/Ao ratio can serve as an alternative for hemodynamic monitoring in facilities with limited resources.