Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review

Background Acute kidney injury (AKI) is one of the most common complications of acute respiratory distress syndrome (ARDS) and significantly increases the mortality rate of ARDS patients. Currently, the clinical understanding of ARDS complicated with AKI, effective prevention and treatment measures are not enough. Exploring the possible predictors is significant for early evaluation and effective intervention measures to reduce the incidence and mortality of AKI in ARDS. Objective To systematically evaluate the risk factors of AKI in ARDS. Methods PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and SinoMed were searched for literatures on risk factors of AKI in ARDS from inception to December 2023. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, extracted data and assessed the quality of included literatures. RevMan 5.3 software was used for Meta-analysis. Results A total of 17 studies involving 6 160 patients were included. Meta-analysis demonstrated that: being older (OR=1.02, 95%CI=1.00-1.03, P=0.007), higher Sequential Organ Failure Assessment (SOFA) scores (OR=1.17, 95%CI=1.05-1.30, P=0.004), diabetes (OR=1.40, 95%CI=1.09-1.80, P=0.008), hypertension (OR=1.56, 95%CI=1.26-1.93, P<0.001), atrial fibrillation (OR=1.76, 95%CI=1.09-2.85, P=0.020), chronic kidney disease (OR=10.31, 95%CI=3.30-32.19, P<0.001), higher neutrophil to lymphocyte ratio (NLR) (OR=1.02, 95%CI=1.00-1.05, P=0.030), higher angiopoietin 2 (Ang-2) (OR=1.84, 95%CI=1.73-1.95, P<0.001), aspartate aminotransferase (AST) >40 U/L (OR=2.27, 95%CI=1.56-3.31, P<0.001), lower arterial blood pH (OR=0.83, 95%CI=0.75-0.92, P=0.000 6), lower glomerular filtration rate (GFR) (OR=0.92, 95%CI=0.75-0.99, P=0.020), mechanical ventilation (OR=2.53, 95%CI=1.96-3.26, P<0.001) and extracorporeal membrane oxygenation (ECMO) (OR=1.81, 95%CI=1.43-2.28, P<0.001) were risk factors for AKI in ARDS. However, gender (OR=1.17, 95%CI=0.82-1.67, P=0.390), BMI (OR=1.27, 95%CI=0.77-2.09, P=0.350), obesity (OR=5.88, 95%CI=0.51-68.28, P=0.160), Acute Physiology and Chronic Health Evaluation Ⅱ scores (OR=1.20, 95%CI=0.99-1.46, P=0.060), heart failure (OR=4.49, 95%CI=0.58-34.70, P=0.150), disturbance of consciousness (OR=1.83, 95%CI=0.88-3.84, P=0.110), pleural effusion (OR=1.16, 95%CI=0.81-1.65, P=0.410), oxygenation index (OR=4.30, 95%CI=0.69-26.77, P=0.120), procalcitonin (OR=1.08, 95%CI=0.95-1.23, P=0.230), white blood cell count (OR=1.56, 95%CI=0.51-4.80, P=0.440) and plasma albumin (OR=1.07, 95%CI=0.97-1.17, P=0.170) were not related to AKI in ARDS. Conclusion The risk factors of AKI in ARDS involve many aspects, including general factors (being older), overall assessment (high SOFA scores), disease factors (combined with diabetes, hypertension, atrial fibrillation and chronic kidney disease), laboratory indicators (higher NLR, higher Ang-2, AST>40 U/L, lower arterial blood pH and GFR), and treatment (mechanical ventilation, ECMO). Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by more high-quality studies in the future.