【Abstract】Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in predicting the occurrence and prognosis of acute kidney injury in patients with sepsis. Methods The prospective observational study enrolled patients with sepsis admitted to the intensive care unit of our hospital from August 2021 to April 2022. The primary outcome was the development of AKI, and the secondary outcomes were persistent AKI and death. The general information and renal function indexes of the patients were collected. The patient was examined by CEUS within 24 hours after admission (Day 1) and on Day 3 (Day 3), and quantitative parameters including peak intensity (PI), time to peak (TTP), and area under the curve (AUC) were obtained. The quantitative parameters of different outcomes were compared. Univariate logistic regression was used to analyze the influencing factors of AKI and its prognosis. The receiver operating characteristic (ROC) curve was used to analyze the value of CEUS in predicting AKI. Results A total of 51 patients with sepsis were enrolled in this study. AKI occurred in 27 patients (52.94%), of which 8 patients (29.63%) developed persistent AKI, and 5 patients (18.52%) died within 28 days. Compared with the non-AKI group, AUC and PI in the AKI group were decreased, and TTP was increased, and the differences were statistically significant (p < 0.05). Compared with AKI continuous group, there was no significant difference in AUC, PI and TTP on Day1 in AKI recovery group (p > 0.05), AUC and PI increased and TTP decreased on Day3, and the differences were statistically significant (p < 0.05). For persistent AKI group, there was no significant difference in AUC, PI and TTP between Day1 and Day3 (p > 0.05). For the AKI recovery group, compared with Day1, the AUC and PI of Day3 were increased, and TTP was decreased, and the differences were statistically significant (p < 0.05). There was no significant difference between the survival group and the death group and among different days (p > 0.05). Univariate logistic regression analysis showed that AUC (0R, 0.880), PI (OR, 0.886) and TTP (OR, 1.076) were the influencing factors for predicting AKI. ROC curve analysis showed that the area under the ROC curve of PI, TTP and AUC for predicting sepsis AKI was 0.70, 0.70 and 0.74, respectively (all p < 0.05). Conclusion Renal perfusion assessed by CEUS can predict the occurrence of acute kidney injury in patients with sepsis, and is related to the prognosis of patients.