Omicron surge impact on acute kidney injury in ICU patients: A study using the ISARIC COVID-19 database

PLoS One. 2025 Nov 20;20(11):e0336843. doi: 10.1371/journal.pone.0336843. eCollection 2025.

ABSTRACT

BACKGROUND: Acute Kidney Injury (AKI) is common among COVID-19 patients and is associated with a higher risk of death. Compared to earlier COVID-19 variants, Omicron has reduced mortality. To study the relationship between Omicron and AKI, we conducted the first international study using the global International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 global dataset.

METHODS: This prospective observational study aims to characterise AKI in a cohort of 3,908 COVID-19 patients admitted to the intensive care unit (ICU) across six countries. Clinical characteristics were compared between Omicron and pre-Omicron patients. Multivariable logistic regression was used to analyse the relationship between the Omicron variant and AKI. AKI was defined based on the change in serum creatinine levels, in accordance with the Kidney Disease Improving Global Outcome AKI guidelines.

RESULTS: Patients admitted to an ICU during the Omicron wave were older and had more comorbidities than pre-Omicron patients. The prevalence of AKI was the same between Omicron and previous variants (24.7% vs 22.9%, p-value = 0.321). Controlling for confounders, ICU patients with the Omicron variant were 30%-40% less likely to develop AKI compared to patients with previous variants. The survival curves between AKI patients with Omicron and non-Omicron variants were consistent with the survival analysis.

CONCLUSION: After adjusting for demographics, comorbidities, laboratory findings, and treatments, patients in ICU during the Omicron wave were less likely to develop AKI compared to previous eras. Nevertheless, the precise influence of the Omicron variant on kidney function remains a subject of ongoing discussion.

PMID:41264626 | PMC:PMC12633887 | DOI:10.1371/journal.pone.0336843