Renal safety of liposomal amphotericin B in critically Ill mechanically ventilated patients with SARS-CoV-2 pneumonia: a retrospective cohort study

Abstract Background Liposomal amphotericin B (L-AmB) is indicated and used in critically ill patients due to its broad spectrum. However, nephrotoxicity remains a concern, particularly in severe patients with organ failure. Objective To evaluate the impact of early L-AmB administration on renal function in mechanically ventilated ICU patients with SARS-CoV-2 pneumonia. Methods Retrospective single-center cohort study including 160 ICU patients with COVID-19. Patients received empiric L-AmB treatment (3 mg/kg/day for 3 days) or no antifungal treatment. Renal function (creatinine levels, oliguria) was assessed at ICU admission, day 3, and hospital discharge. Acute Kidney Injury (AKI) was defined per KDIGO criteria. Multivariate logistic regression identified predictors of AKI. Results 102 patients received L-AmB empiric treatment. No significant differences in creatinine were observed at admission or ICU day 3. AKI incidence at discharge was significantly lower in the L-AmB treated group (31.6% vs. 56.9%, p=0.002). Empiric L-AmB treatment was not associated with AKI risk (OR=0.18; 95% CI: 0.05–0.63; p=0.007). Diabetes and high creatinine at day 3 were risk factors for AKI. Conclusion Empiric L-AmB treatment appears safe and was not associated with AKI incidence in critically ill COVID-19 patients. Clinical trial number Not applicable.