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Background Galectin-3 (Gal-3) is a proinflammatory and profibrotic protein especially overexpressed after Acute Kidney Injury (AKI). The early renal prognostic value of Gal-3 after AKI in critically ill patients remains unexplored. The objective was to evaluate the prognostic value of plasma level of Gal-3 for Major Adverse Kidney Events (MAKE) and mortality 30 days after ICU admission across AKI stages. Methods This is an ancillary study of a prospective, observational, multicenter cohort (FROG-ICU). AKI was defined using KDIGO definition. Results Two thousand and seventy-six patients had a Gal-3 plasma level measurement at ICU admission. Seven hundred and twenty-three (34.8%) were females and the median age was 63 [51, 74] years. Eight hundred and seven (38.9%) patients developed MAKE, 774 (37.3%) had AKI and mortality rate at 30 days was 22.4% ( N  = 465). Patients who developed MAKE had higher Gal-3 level at admission compared to patients without (30.2 [20.8, 49.2] ng/ml versus 16.9 [12.7, 24.3] ng/ml,  p  &lt; 0.001, respectively. The area under the receiver operating characteristic curve of Gal-3 to predict MAKE was 0.76 CI 95%  [0.74–0.78],  p  &lt; 0.001. Gal-3 was associated with MAKE (OR 1.80 CI 95%  [1.68–1.93],  p  &lt; 0.001, non-adjusted and OR 1.37 CI 95%  [1.27–1.49],  p  &lt; 0.001, adjusted). The use of Gal-3 improved prediction performance of prediction model including SAPSII, Screat adm , pNGAL with a NRI of 0.27 CI 95% (0.16–0.38), p &lt; 0.001. Median Gal-3 was higher in non-survivors than in survivors at 30 days (29.2 [20.2, 49.2] ng/ml versus 18.8 [13.3, 29.2] ng/ml,  p  &lt; 0.001, respectively). Conclusion Plasma levels of Gal-3 were strongly associated with renal function, with an increased risk of MAKE and death after ICU admission. Trial registration  ClinicalTrials.gov NCT01367093. Registered on 6 June 2011. Graphical abstract

Elevated plasma Galectin-3 is associated with major adverse kidney events and death after ICU admission