Association of glucocorticoids with outcomes in critically ill patients with sepsis-associated acute kidney injury: a multicenter retrospective cohort study.

The impact of glucocorticoid therapy on mortality and renal function recovery in patients with sepsis-associated acute kidney injury (SA-AKI) remains unclear. A multicenter retrospective study was conducted using data from the Medical Information Mart for Intensive Care (MIMIC)-IV and the electronic ICU Collaborative Research Database (eICU-CRD). Of 8,759 SA-AKI patients, 1,334 received glucocorticoids and 7,425 did not. After adjustment, glucocorticoid treatment was associated with an increased risk of ICU mortality (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.07-1.41; P = 0.004) and in-hospital mortality (HR 1.16; 95% CI 1.02-1.32; P = 0.021). However, no statistically significant association was found between glucocorticoid use and renal function recovery (odds ratio [OR] 0.98; 95% CI 0.85-1.13; P = 0.796). Subgroup analysis suggested that dexamethasone use was associated with improved renal function recovery (OR 1.55; 95% CI 1.02-2.35; P = 0.04). In critically ill patients with SA-AKI, glucocorticoid therapy was associated with increased ICU and in-hospital mortality, without significant benefits in overall renal function recovery. However, dexamethasone may be linked to better renal function recovery. Further validation through randomized controlled trials is warranted to clarify the potential benefits and risks of glucocorticoid therapy in SA-AKI.