BACKGROUND This study investigated the risk factors affecting development and prognosis of acute kidney injury (AKI) in patients with acute respiratory distress syndrome (ARDS). MATERIAL AND METHODS A total of 501 ARDS cases were retrospectively enrolled (296 males and 205 females) admitted to the First People's Hospital of Lianyungang from Aug 2015 to Aug 2017. Multivariable logistic modeling was conducted to select significant variables, and the assigned integer score was proportional to the adjusted odds ratio (OR). Then, the sum of weighted variables was utilized to estimate the score in patients. RESULTS Patients with ARDS who had unconsciousness (OR=2.778, 95% CI: 1.396-5.528), hypertension (OR=1.771, 95% CI: 1.089-2.881), ARDS (moderate-severe) (OR=1.630, 95% CI: 1.027-2.588), AST (OR=2.093, 95% CI: 1.251-3.499), and D-dimer (OR=2.372, 95% CI: 1.316-4.275) were more likely to also have AKI. The score was allocated in proportion to the corresponding adjusted OR, hypertension, ARDS (moderate-severe), aspartate aminotransferase (AST), D-dimer (2 points each), and unconsciousness (3 points). The incidences of AKI in group A (score 0-2, n=9), group B (score 3-4, n=16), group C (score 5-6, n=33), and group D (score ≥7, n=72) were 10.98%, 16.00%, 31.13%, and 49.66%, respectively (P<0.001). Higher scores were associated with higher prevalence of AKI, and the trend was statistically significant (P<0.001). CONCLUSIONS This scoring system may provide a risk-integrative evaluation for AKI in patients with ARDS.