Abstract
PURPOSE: Metabolic syndrome (MetS) is linked to adverse outcomes in chronic diseases, but its impact on acute kidney injury (AKI) in elderly critically ill patients remains unclear. This study aimed to evaluate the association between MetS and 90-day mortality in this population. PATIENTS AND METHODS: A retrospective analysis included 774 elderly patients (≥65 years) with AKI admitted to the ICU from January 2022 to December 2023. MetS was defined as the presence of at least three of the following: central obesity, hypertension, dyslipidemia, and hyperglycemia. Propensity score matching (PSM) balanced baseline characteristics between MetS and non-MetS groups. The primary outcome was 90-day all-cause mortality, and the secondary outcome was renal recovery at discharge. Multivariate Cox regression assessed the independent association of MetS with 90-day mortality. RESULTS: After PSM, 294 patients (147 MetS and 147 non-MetS) were included. The MetS group had a significantly higher 90-day mortality rate compared to the non-MetS group (44.9% vs 31.3%, p=0.016). Multivariate analysis showed that MetS was independently associated with an increased risk of mortality (HR=1.606, 95% CI: 1.080-2.386; p=0.019). A dose-response relationship was observed, with increasing number of MetS components associated with higher mortality risk (HR=1.382, 95% CI: 1.121-1.831; p=0.001). Additionally, patients with MetS had lower rates of full renal recovery compared to those without (74.8% vs 86.4%, p=0.040). CONCLUSION: MetS is independently associated with increased 90-day mortality and impaired renal recovery in elderly critically ill patients with AKI.