Preexisting cancer is associated with a higher incidence of acute kidney injury and mortality in the critically ill which is not mediated by neutrophil extracellular traps

It is well established that critically ill patients have increased risk for acute kidney injury (AKI) and mortality. In the recent years, the covid-19 pandemic was responsible for the majority of ICU admissions world-wide. As covid-19 is an infection that in numerous cases starts an immune overdrive, many covid-19 patients developed sepsis. Sepsis is a syndrome with multiple organ failure due to an infection. Neutrophil activation and the subsequent NETs (neutrophil extracellular traps) formation have been suggested to play a role in the organ failure seen in sepsis. The kidneys are one of the first organ systems to fail and it was seen that covid-19 patients with AKI had a mortality rate of 80% instead of the non-AKI mortality rate of 30%. NETs have also been associated with morbidity and mortality in cancer. Therefore, the hypothesis here is that the critically ill patients with cancer have a higher rate of AKI and mortality than those with no cancer, which are associated with increased levels of NETs. Positive covid-19, critically ill, patients (admitted to the ICU) were included in a cohort at Uppsala University Hospital. Primary outcomes were incidence of AKI (by KDIGO), in-hospital mortality, and 30-day mortality in critically ill patients with or without preexisting malignancies. Secondary outcomes were plasma levels of NETs. These were investigated with the markers: neutrophil elastase - NE, circulating free DNA - cfDNA, growth arrest specific protein 6 - GAS6, histone 3 - H3. Chi-Square, multiple logistic regression, and t-test were used for statistical analysis at 95% significance level. A total of 372 patients were included in the cohort whereas 35 (9%) had cancer and 337 (91%) did not. The incidence of AKI was significantly higher in the cancer group relative to the non-cancer group (p<0.0001): 63% (n=22) of the patients with cancer and 48% (n=157) of the non-cancer patients. The in-hospital and 30-day mortality were also higher among critically ill patients with cancer than the non-cancer patients (p=0.013; p<0.001). 29% (n=10) and 14% (n=47) in the cancer and non-cancer group respectively, died before ICU discharge. 37% (n=13) and 16% (n=53) in the cancer and non-cancer group respectively, died within 30 days. Plasma levels of NETs markers did not differ between the cancer group and non-cancer group. In this cohort of critically ill patients, cancer was confirmed a risk factor for 30-day mortality (p=0.008). Cancer was not statistically confirmed a risk factor for AKI (p=0.08), most likely the effect of a small sample size (only n=35 with cancer). These data concludes that critically ill patients with cancer have higher incidence of AKI and mortality than the critically ill non-cancer patients. However, NETs do not seem to be linked to the difference seen between these groups. Cancer was found to be an independent risk factor for mortality in this critically ill population. The cohort and biobank is a part of the PronMed-study. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.