Echocardiographic left ventricular filling pressure (E/e′) and incident acute kidney injury in critically ill adults with preserved ejection fraction

<title>Abstract</title> <p>Acute kidney injury (AKI) is common in critical illness, and elevated left ventricular filling pressure may contribute through venous congestion. We examined whether the echocardiographic ratio E/e′, a non-invasive estimate of filling pressure, is independently associated with incident AKI in critically ill adults with preserved ejection fraction. Using the MIMIC-IV critical care database linked to the MIMIC-IV-ECHO module (single US centre, 2008–2022), we conducted a retrospective cohort study of 3,067 adults with a first ICU admission, preserved ejection fraction (≥ 50%) and an interpretable mean E/e′ on peri-admission echocardiography, excluding those with end-stage renal disease, significant mitral disease or prevalent AKI. The outcome was incident AKI (KDIGO serum-creatinine criteria) within 7 days of the index echocardiogram, with early death as a competing event. AKI occurred in 588 patients (19.2%), and crude 7-day incidence rose across E/e′ categories (16.1%, 18.7%, 26.7%). In a Fine–Gray model adjusted for acute-severity and comorbidity covariates, each 1-unit higher E/e′ was associated with incident AKI (subdistribution hazard ratio 1.030, 95% CI 1.013–1.047), with concordant estimates across logistic, modified-Poisson and dichotomous (&gt; 14 versus ≤ 14: odds ratio 1.47, 1.15–1.87) analyses. The association was independent of acute illness severity. Prospective, multicentre confirmation is warranted.</p>