AKI in Severe Legionnaires’ Disease in Intensive Care Unit

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Introduction Legionnaires' disease (LD) can cause severe pneumonia requiring intensive care and frequently associated with multiorgan failure. The mechanisms and prognosis of kidney complications in LD remain poorly characterized. We aimed to describe the incidence, clinical characteristics, and prognosis of AKI in critically ill patients with LD and identify factors associated with AKI, in a multicenter cohort. Methods This multicenter retrospective cohort study was conducted in 39 ICUs in France between 2012 and 2024. Inclusion criteria were a diagnosis of LD requiring invasive mechanical ventilation. Results 561 patients were included. Patients exhibited high severity, with a mean SOFA score on D1 of 7.9; 69% with severe ARDS and 81% with septic shock. The incidence of AKI was 74% in ICU, with 44% requiring renal replacement therapy (RRT). Rhabdomyolysis (16%), hematuria (52%) and proteinuria (mean 1.49 g/L) were commonly observed. Rhabdomyolysis was an independent risk factor for AKI and RRT requirement: aOR 3.99 [1.59-10.00], p=0.003 and aOR 4.07 [2.17-7.63], p<0.001, respectively. RRT requirement was associated with significantly increased mortality: aOR 2.49 [1.27-4.87], p=0.008 at D28, pLog-rank<0.001. In an exploratory analysis, dual anti-Legionella antibiotic therapy, administered in 87% of cases, was independently associated with lower day-28 mortality (aOR 0.27 [95% CI 0.13–0.58], p=0.001). Conclusion AKI appears highly incident in patients with severe LD, with a high frequency of rhabdomyolysis and proteinuria, suggesting marked kidney involvement. Rhabdomyolysis was independently associated with AKI onset and RRT requirement. AKI was associated with significantly increased mortality, whereas anti-legionella dual therapy was protective.