Objective:To investigate the expression of long non-coding RNA growth retard-specific transcript 5 (LncRNA GAS5) and micrornas (miR) 23a-3p in patients with sepsis complicated with acute kidney injury (AKI) and their clinical significance.Methods:A total of 206 patients with sepsis admitted to the Department of Emergency Medicine, Fuyang First Hospital Affiliated to Binjiang College of Zhejiang University of Traditional Chinese Medicine from May 2020 to February 2023 were prospectively selected and divided into AKI group (95 cases) and control group (111 cases) according to whether they had concurrent AKI. Serum LncRNA GAS5 and miR-23a-3p expressions were detected. logistic regression analysis was used to screen the influencing factors of patients with sepsis complicated with AKI, and receiver operating characteristic (ROC) curve was used to analyze the value of LncRNA GAS5 and miR-23a-3p in predicting sepsis complicated with AKI.Results:Mechanical ventilation, blood transfusion treatment ratio, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Sequential Organ Failure Assessment (SOFA) score, white blood cell count (WBC), serum C-reactive protein (CRP), procalcitonin (PCT), blood urea nitrogen (BUN), Scr, blood lactic acid level of the AKI group were higher than those of the control group (all P<0.05); mean arterial pressure (MAP), urine volume, estimate glomerular filtration rate (eGFR) at admission were lower than those of the control group (all P<0.05). Serum LncRNA GAS5 expression (5.12±1.69 vs 2.30±0.42) in AKI group was higher than that in the control group ( P<0.05), and miR-23a-3p expression (1.05±0.13 vs 3.04±0.67) was lower than that in the control group ( P<0.05). Logistic regression analysis showed that high APACHE Ⅱ score, high SOFA score and high expression of LncRNA GAS5 were risk factors for AKI in sepsis patients (all P<0.05). High eGFR and high expression of miR-23a-3p were protective factors (all P<0.05). The area under the curve (AUC) predicted by LncRNA GAS5 and miR-23a-3p for patients with sepsis complicated with AKI was 0.808 and 0.759, and the AUC of combined prediction was 0.882, which was higher than that predicted by single indicator. Conclusions:The expression of LncRNA GAS5 is up-regulated and the expression of miR-23a-3p is down-regulated in serum of patients with sepsis complicated with AKI. The combined detection of LncRNA GAS5 and miR-23a-3p is of high value in predicting the risk of AKI in patients with sepsis.