Renin and 1-year mortality in critically ill patients with ARDS: trajectories, discrimination, and survival analysis

The study examined the association between plasma renin concentration and 1-year mortality in 104 critically ill patients with COVID-19-related acute respiratory distress syndrome (ARDS). Renin was measured at 72, 120, and 168 hours after admission to the intensive care unit. Chronic renin-angiotensin-aldosterone system inhibitors were discontinued upon admission. Forty-six percent of patients (48 of 104) died within one year. Higher renin levels were associated with increased mortality at all measured time points. In multivariable analysis, independent predictors of 1-year mortality were renin at 72 hours, the PaO₂/FiO₂ ratio, and procalcitonin at 168 hours. The model demonstrated high discriminatory ability with an AUC of 0.941. The results indicate that early renin measurement is independently associated with 1-year mortality in patients with severe COVID-19-related ARDS.