What does this research mean for the field?

Persistent severe acute kidney injury (PS-AKI) is associated with a 54% in-hospital mortality rate and only a 17% renal recovery rate among critically ill patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

The study aims to explore the outcomes and predictive markers associated with persistent severe acute kidney injury (PS-AKI) in critically ill patients.

February 19, 2026Open Access

Persistent Severe Acute Kidney Injury Among Critically Ill Patients: Outcomes and Predictive Markers—A Single‐Center Retrospective Cohort Study

Puntos clave

The study aims to explore the outcomes and predictive markers associated with persistent severe acute kidney injury (PS-AKI) in critically ill patients.
Retrospective analysis of critically ill adults in a tertiary ICU from January 2024 to June 2025.
Classification of acute kidney injury (AKI) according to KDIGO 2012 guidelines into various stages, including persistent severe AKI.
Logistic regression and gradient boosting methods used to explore predictors of PS-AKI.
Among 106 patients with AKI, 23% had PS-AKI, which was linked to a 54% in-hospital mortality rate.
PS-AKI was associated with significantly lower rates of renal recovery at only 17%.
Inflammatory markers, particularly the composite NLR-to-platelet ratio, were strongly associated with PS-AKI.

Resumen

Background Persistent severe acute kidney injury (PS‐AKI)—recently standardized as Kidney Disease: Improving Global Outcomes (KDIGO) Stage 3 persisting ≥ 72 h, or renal replacement therapy/death after Stage 3 diagnosis—has emerged as a trajectory‐based phenotype complementing conventional KDIGO staging. Evidence in contemporary intensive care unit (ICU) cohorts remains limited. Methods We retrospectively studied adults admitted to a tertiary ICU (January 2024–June 2025). Acute kidney injury (AKI) was staged per KDIGO 2012, with trajectories classified as Stage 1 AKI, transient AKI (Stage 2‐3 resolving within 48 h), persistent mild–moderate AKI, or PS‐AKI. The primary outcome was in‐hospital mortality; secondary outcomes included renal recovery. Predictors of PS‐AKI were explored using logistic regression and gradient boosting with SHAP attribution. Results Among 139 ICU patients with AKI screened, 106 met criteria. Most AKI was community‐acquired (97/106, 91.5%). PS‐AKI accounted for 23% (24/106) and carried the worst outcomes, with in‐hospital mortality 54% and renal recovery 17%. Within Stage 2‐3, PS‐AKI was associated with substantially worse outcomes than non‐PS trajectories (mortality 54% vs 10.8%; adjusted HR for death 2.23, 95% CI 0.69–7.21; adjusted OR for renal recovery 0.07, 95% CI 0.01–0.24). A 72‐h landmark analysis showed similar but nonsignificant trends. Inflammatory profiles distinguished PS‐AKI, with higher neutrophil‐to‐lymphocyte ratio (NLR), C‐reactive protein (CRP), and lower platelets. The composite NLR‐to‐platelet ratio (NLR/PLT) was independently associated with PS‐AKI (adjusted OR 2.51 per doubling, 95% CI 1.52–4.12; AUC 0.86), while the systemic immune‐inflammation index (SII) showed no significant association. Conclusions In this predominant community‐acquired ICU cohort, PS‐AKI was common and strongly associated with poor in‐hospital outcomes. The co‐occurrence of inflammation and thrombocytopenia, summarized by NLR/PLT, may represent a simple exploratory signal for early‐risk appraisal. These findings support further research into trajectory‐based AKI phenotypes and the potential utility of inflammation–hematologic markers in predicting persistence.

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