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Prediction of acute kidney injury in mechanically ventilated patients with COVID-19-related septic shock: An exploratory analysis of non-renal organ dysfunction markers Cover

Prediction of acute kidney injury in mechanically ventilated patients with COVID-19-related septic shock: An exploratory analysis of non-renal organ dysfunction markers

The Journal of Critical Care Medicine
Volume 12 (2026): Issue 2 (April 2026)
By: ,   and    
Open Access
|Apr 2026
Figures & tables

Figures & Tables

Fig. 1.

Study flowchart

Fig. 2.

A. Creatinine prediction; B. Urinary flow prediction

Fig. 3.

Path analysis illustrating direct and indirect clinical and biochemical contributors to AKI (A) and severe AKI (B).

Fig. 4.

Urinary output prediction

Baseline characteristics of the study population

VariableNo Severe AKI (36)Severe AKI (6)Total (42)p-value
Baseline Characteristics
Age (years)53.5 (45-60.5)54 (49-72)53.5 (45-61)0.69
Male sex (%)30 (83)6 (100)36 (85)0.56
Height (cm)171.5 (165-176.5)172.5 (163-187)171.5 (165-177)0.44
Weight (kg)84 (75.5-93)90.5 (75-102)85 (75-95)0.55
Diabetes Mellitus9 (25)4 (66)13 (31)0.06
COPD1 (3)01 (2.38)0.67
Hypertension9 (25)2 (33)11 (26.1)0.64
Obesity19 (53)4 (67)23 (54.7)0.67
OSAS3 (8)03 (7.14)0.46
Smoking1 (3)01 (2.38)0.67
Immunosuppression3 (8)03 (7.14)0.46
Hypothyroidism1 (3)01 (2.38)0.67
Hematologic syndrome3 (8)03 (7.14)0.46
Days of evolution9 (7-12)8 (7-11)9 (7-12)0.88
Days to intubation10 (8-13.5)10.5 (8-14)10 (8-14)0.81
Baseline creatinine(mg/dl)0.6 (0.5-0.7)0.75 (0.6-1.2)0.6 (0.5-0.7)0.09
eGFR, ml/min/1.73m2113 (104-125)97 (69-118)112 (103-124)0.20
Day one variables
Total SOFA6 (5.5-7)5.5 (5-6)6 (5-7)0.27
Respiratory SOFA3 (3-3)2.5 (2-3)3 (3-3)0.04*
Cardiovascular SOFA3 (3-3)3 (3-3)3 (3-3)0.72
Renal SOFA0 (0-0)0 (0-0)0 (0-0)0.33
Hematologic SOFA0 (0-0)0 (0-0)0 (0-0)0.68
Hepatic SOFA0 (0-0)0 (0-0)0 (0-0)0.54
Neurological SOFA0 (0-0)0 (0-0)0 (0-0)0.38
Maximum lactate1.7 (1.4-2.4)1.7 (1.4-2.3)1.7 (1.4-2.3)0.97
Minimum lactate1.6 (1.3-1.9)1.55 (1.2-1.8)1.6 (1.3-1.8)0.92
Maximum heart rate84.5 (78.5-93.5)86 (83-105)84.5 (80-94)0.56
Minimum heart rate58 (51-63)64.5 (52-74)58 (52-65)0.23
Maximum PAM94.5 (90-100)96 (90-98)95 (90-99)0.82
Minimum PAM71 (68.5-74)69 (63-73)71 (68-74)0.27
Maximum PEEP12 (10-12)11 (10-12)12 (10-12)0.52
Minimum PEEP10 (9-11.5)11 (10-12)10 (9-12)0.35
PaO2 / FiO2147 (114-176.5)218 (189-242)151 (124-192)0.01*
Sevoflurane16 (44)4 (66)20 (47.62)0.40
Fentanyl31 (86)6 (100)37 (88.1)0.33
Remifentanil4 (11)04 (9.52)0.39
Cisatracurio/Rocuronio14 (38)014 (33.3)0.06
Norepinephrine32 (89)6 (100)38 (90.4)0.39
Norepinephrine dose (µ/kg/h)0.032 (0.014-0.076)0.045 (0.019 – 0.085)0.032 (0.018 – 0.081)0.67
Fluid balance (ml)10.5 (-619-414)356 (153-1663)69.5 (-594-478)0.22
Urinary output (ml)1687.5 (995-2200)1421 (750-2130)1652.5 (980-2130)0.56
Hb15.3 (14.1-16.4)14.2 (13.9-16.5)15.1 (13.9-16.5)0.57
Platelets233 (200-312)269 (199-321)233.5 (199-317)0.91
Leukocytes11.36 (6.94-13.73)11.62 (7.49-13.39)11.36 (7.15-13.7)0.71
Neutrophil9.57 (5.9-11.77)10.52 (5.83-11.78)9.71 (5.83-11.78)0.73
Lymphocytes0.9 (0.7-1.26)0.86 (0.57-1)0.91 (0.66-1.23)0.43
Creatinine0.75 (0.7-0.85)0.9 (0.6-1.2)0.75 (0.7-0.9)0.52
BUN16 (13-21.5)17 (12-24)16 (13-22)0.85
Total bilirubin0.65 (0.44-0.83)0.79 (0.38-0.95)0.65 (0.44-0.83)0.68
AST47.5 (35-66)42 (32-51)46 (34-66)0.59
ALT42.5 (27-54)54.5 (35.5-69)46 (27-56)0.41
LDH456 (390-519)376 (323-452)444 (369-513)0.13
Albumin3 (2.7-3.4)3.3 (3-3.6)3 (2.8-3.5)0.24
Na139.5 (137-142)140 (139-141)140 (137-142)0.85
K4.1 (3.8-4.6)4.4 (4.1-4.8)4.15 (3.8-4.6)0.24
Ca8.5 (8.1-8.7)8.8 (8.7-8.9)8.5 (8.1-8.8)0.23
Procalcitonin0.16 (0.7-0.44)0.33 (0.09-0.56)0.16 (0.07-0.55)0.73
D dimer1095.9 (566-1740)995 (665-3592)1095.9 (607-1764)0.61
Ferritin1282 (649-2273)742 (625.3-792)1070.5 (625.3-2273)0.42
C-reactive protein23 (17.8-36.6)17.75 (11.25-30.95)23.4 (17-36.6)0.32
Fibrinogen706 (641-782)635 (528-807)706 (583-782)0.86
Outcomes
Delirium13 (36)1 (17)14 (33.3)0.64
VAP18 (50)2 (33)20 (47.62)0.66
Antipsychotics19 (52)3 (50)22 (52.38)0.90
MV time (hours)194 (137-276)152 (114-218)190 (125-241)0.86
Reintubation6 (17)1 (17)7 (16.6)1.0
Propofol days7 (4-8)6.5 (5-8)7 (4-8)0.91
Opioid days7 (5.5-8)6.5 (5-8)7 (5-8)0.74
Days of dexmedetomidine8 (6.5-8)7 (6-8)8 (6-8)0.58
Neuromuscular blocker days4.5 (3-7.5)2 (2-3)4 (2-7)0.03*
Days in ICU or hospital17 (14-24.5)15 (11-19)16.5 (13-23)0.45
Death in hospital4 (11)1 (16)5 (11.9)0.69

Simplified logistic regression model with bootstrapped confidence intervals for the prediction of AKI_

Predictor (Day 1)Odds Ratio (OR)Bootstrap 95% CIP-value
Norepinephrine Dose (µg/kg/min)1.020.95 – 1.100.486
Hemoglobin (g/dL)0.700.45 – 1.030.085
DOI: https://doi.org/10.62838/jccm-2026-0005 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Journal RSS Feed
Language: English
Page range: 176 - 185
Submitted on: Jun 14, 2025
Accepted on: Jan 18, 2026
Published on: Apr 30, 2026
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
acute kidney injury,
organ dysfunction,
acute kidney injury prediction,
critical care,
intensive care unit,
SOFA score,
APACHE II score
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2026 Jose J. Zaragoza, Jonathan S. Chávez-Iñiguez, Armando Vazquez-Rangel, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 12 (2026): Issue 2 (April 2026)
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