Background  Acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) are common complications in intensive care unit (ICU) patients. AKI is a risk factor for ARDS, and the mortality of patients increases significantly when AKI is combined with ARDS.

  Objective  To analyze the risk factors of acute respiratory distress syndrome and adverse prognosis in patients with acute kidney injury in intensive care units.

  Methods  Clinical data about AKI patients in intensive care unit of the First Medical Center of Chinese PLA General Hospital from January 1, 2013 to January 1, 2020 were retrospectively analyzed. There were 154 cases in ARDS group and 102 cases in non-ARDS group. According to the occurrence of adverse prognosis, 164 patients were in the adverse prognosis group and 92 patients in the normal discharge group. Univariable and multivariable logistic regression were used to analyze the risk factors of ARDS and adverse prognosis in patients with AKI.

  Results  By adjusting confounding factors, the results of multivariable analysis showed that stage 3 AKI (OR: 4.81, 95% CI: 2.20 - 10.54), renal AKI (OR: 6.00, 95% CI: 2.87 - 12.56) and application of vasoactive drugs (OR: 3.72, 95% CI: 1.70 - 8.12) were independent risk factors of ARDS. Age (OR: 1.02, 95% CI: 1.01 - 1.04), shock (OR: 3.12, 95% CI: 1.62 - 6.00) and stage 3 AKI (OR: 3.44, 95% CI: 1.61 - 7.35) were independent risk factors of adverse prognosis. Patients in the poor prognosis group had lower body temperature (OR: 0.66, 95% CI: 0.45-0.97), and shorter length of stay in ICU (OR: 0.99, 95% CI: 0.98 - 0.99).

  Conclusion  Stage 3 AKI, renal AKI and application of vasoactive drugs are independent risk factors for ARDS in patients with AKI in intensive care units. Patients with adverse prognosis have lower body temperature at admission. Age, shock and stage 3 AKI are independent risk factors for adverse prognosis.