Objective To explore the intervention effect of hierarchal accountability nursing based on the modified early warning scoring（MEWS） system in the care of patients with acute kidney injury in the intensive care unit（ICU）.Methods Forty patients with acute kidney injury admittecl to a hospital in Henan province from February 2018 to March 2019 were selected as the study subjects and set as the control group;40 patients with acute kidney injury admittecl to a hospital in Henan province from April 2019 to May 2020 were selected as the study subjects and set as the intervention group.Patients in the control group underwent conventional ICU nursing interventions

and patients in the intervention group underwent MEWS-based hierarchical accountability nursing interventions on the basis of the control group.The total resuscitation time

length of stay at ICU

and total length of stay of the patients in the two groups were compared;the scores of the acute physiology and chronic health evaluation II（APACHE Ⅱ）

hamilton anxiety scale（HAMA）

and hamilton depression scale（HAMD） before and at 7 d of the intervention were compared between the two groups.Patient satisfaction with care was compared between the 2 groups.Results The total resuscitation time

ICU stay and total hospital stay of patients in the intervention group were shorter than those in the control group

and the differences were statistically significant（P< 0.05）.Before the intervention

there was no statistically significant difference between the APACHE Ⅱ

HAMA and HAMD scores of patients in the 2 groups（P>0.05）.After the intervention

the APACHE Ⅱ

HAMA and HAMD scores of patients in the 2 groups were lower than before the intervention

and the intervention group was lower than the control group

and the differences were statistically significant（P<0.05）.The total nursing satisfaction of patients in the intervention group was 97.50%

which was higher than that of 80.00% in the control group

and the difference was statistically significant（P<0.05）.Conclusion The effect of ICU patients with acute kidney injury receiving MEWS-based hierarchical accountability nursing intervention was significant.This intervention shortened the total resuscitation time

ICU stay

and total hospital stay

reduced the severity of patients’ conditions

improved patients’ psychological status

and increased patients’ nursing satisfaction.