Impact of Acute Kidney Injury on Mortality Outcomes in Pa-tients Hospitalized for COPD Exacerbation: A National Inpa-tient Sample Analysis

Background: Acute kidney injury (AKI)worsens outcomes in COPD exacerbations (COPDe), yet limited data compare the demographics and mortality risk factors of COPDe admissions with and without AKI. Understanding this association may enhance risk stratification and management strategies. Objective: To identify demographic differences and mortality risk factors in COPDe admissions with and without AKI. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from January 1, 2016, to January 1, 2021. Patients aged ≥35 years with a history of smoking and a diagnosis of COPDe were included. Patients with CKD stage 5, end-stage kidney disease (ESKD), heart failure decompensation, urinary tract infections, myocardial in-farction, alpha-1 antitrypsin deficiency, or active COVID-19 infection were excluded. Baseline demographics were analyzed using descriptive statistics. Multivariate analysis was used to measure the odds ratio (OR) of mortality. Statistical analyses were conducted using IBM SPSS, with statistical significance at p < 0.05. Results: Among 405,845 hospi-talized COPDe patients, 13.6% had AKI. These patients were older, had longer hospital stays, and included fewer females and White patients. AKI was associated with signifi-cantly higher mortality (OR: 2.417), more frequent acute respiratory failure (OR: 4.559), intubation (OR: 10.262), and vasopressor use (OR: 2.736). CVA, pneumonia, and pul-monary hypertension were significant mortality predictors. Hypertension, CAD, and diabetes were associated with lower mortality. Conclusion: AKI in COPDe admissions is associated with worse outcomes. Protective effects from certain comorbidities may relate to renoprotective medications. Study limitations include coding errors and retrospective design.