Outcomes of acute kidney injury in critically ill adults with tropical acute febrile illness: Prospective observational study

doi:10.5492/wjccm.v15.i2.118803

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Crit Care Med. Jun 9, 2026; 15(2): 118803
Published online Jun 9, 2026. doi: 10.5492/wjccm.v15.i2.118803

Outcomes of acute kidney injury in critically ill adults with tropical acute febrile illness: Prospective observational study

Sankalp Ranjan, Srishti Jain, Puneet Panwar, Ashish Jain, Ravi Jain

Sankalp Ranjan, Srishti Jain, Puneet Panwar, Ashish Jain, Ravi Jain, Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur 302022, Rajasthan, India

Co-first authors: Sankalp Ranjan and Srishti Jain.

Author contributions: Ranjan S, Jain A, and Jain R conceptualize the study, analysed the data, reviewed, edited the initial manuscript and prepared and reviewed final manuscript; Ranjan S, Jain S, and Panwar P did the data harvesting, curation, investigation; Ranjan S and Jain R wrote the initial manuscript and all the authors provide critical input in final review and preparation of the manuscript. Ranjan S and Jain S contributed equally to this work as co-first authors.

Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of Mahatma Gandhi Medical College and Hospital (Approval No. MGMC&H/IEC/JPR/2024/4127).

Informed consent statement: Written informed consent was obtained from all participants or their legally authorized representatives prior to enrolment in the study.

Conflict-of-interest statement: The authors declare no conflicts of interest pertinent to this project.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The technical appendix, statistical code, and de-identified dataset will be made available from the corresponding author upon reasonable request, subject to approval by the institutional authorities.

Corresponding author: Ravi Jain, MD, Associate Professor, Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur 302022, Rajasthan, India. ravijainstar@gmail.com

Received: January 13, 2026
Revised: January 29, 2026
Accepted: February 24, 2026
Published online: June 9, 2026
Processing time: 129 Days and 18.6 Hours

Abstract

BACKGROUND

Tropical acute febrile illness (TAFI) is a major illness with a large number of intensive care unit (ICU) admissions in tropical regions. It is frequently complicated by acute kidney injury (AKI) and associated poor outcomes. The data on the predictors of outcomes, in terms of in-hospital mortality and renal outcomes, amongst critically-ill TAFI patients from our region remain limited.

AIM

To evaluate the clinical profile and outcomes of AKI amongst critically-ill TAFI patients and to identify the factors associated with in-hospital mortality.

METHODS

This prospective observational cohort study was conducted amongst the patients admitted in ICU at a tertiary care teaching hospital in the state of Rajasthan (India) between June and September 2025. Adult patients (aged ≥ 18 years), with laboratory-confirmed TAFI and AKI diagnosed using AKI network criteria, were included in the study. Demographic, clinical, laboratory, and organ-support variables were recorded. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included renal recovery at the time of discharge and a composite net negative outcome (NNO) (defined as in-hospital mortality or persistent renal dysfunction during discharge). Univariate and exploratory multivariable logistic regression analyses were conducted to identify the predictors of the outcomes.

RESULTS

The data collected from a total of 68 critically-ill TAFI patients with AKI was analyzed. Their median age was 52 years while 37 (54.4%) were females. Scrub typhus 43 (63.24%) was found to be the most common etiology, followed by dengue 9 (13.24%). AKI stage I was found to be the most frequent (37; 54.4%) at ICU admission, while 19 (27.94%) required renal replacement therapy. Overall, the in-hospital mortality was 8 (11.8%) while NNO was observed in 23 (33.8%) patients. In terms of multivariable analysis, higher APACHE II scores and lower arterial oxygen tension at admission independently predicted the mortality. Dialysis requirement was found to be a strong predictor of NNO (odds ratio 21.95), along with hypoxemia and greater illness severity.

CONCLUSION

AKI in critically-ill TAFI patients has the modest mortality yet it results in substantial morbidity and incomplete renal recovery outcomes. Early hypoxemia, illness severity, and the need for dialysis are the key predictors of adverse outcomes. The study findings emphasize the importance of a comprehensive severity assessment beyond the existing creatinine-based AKI staging method.

Keywords: Tropical acute febrile illness; Tropical fever; Acute kidney injury; In-hospital mortality; Persistent renal injury; Observational cohort study; Outcome predictors; Scrub typhus; Dengue; Multiple organ dysfunction syndrome

Core Tip: Acute kidney injury (AKI) with tropical acute febrile illness is associated with significant morbidity and low mortality. Early hypoxemia, higher illness severity scores, and the requirement for dialysis independently predict adverse outcomes. This study highlights the need for early risk stratification in this patient subgroup beyond creatinine-based AKI staging.