Clinical Impact of Wnt5a Expression on the Persistence of AKI in Patients with Urosepsis

Background: This study aimed to investigate the association between Wnt5a values and organ alterations in urosepsis patients. Methods: Serum creatinine (Cr) and Wnt5a levels were measured in 28 healthy volunteers and on day 1, 5, and discharge day in 87 urosepsis patients. The patients were classified into an improving AKI group and a worsening AKI one by comparing the stages of AKI on day 1 and 5. The impacts of Wnt5a values on major adverse kidney events (MAKE), stage 3 AKI, new renal replacement therapy (RRT), and death. Logistic regression analysis was performed to determine the probability of clinical outcomes. Reversal patterns after AKI were also evaluated. Results: Wnt5a levels were significantly elevated in urosepsis patients compared to healthy volunteers (P=0.009). There were 28 (32.2%) in the worsening AKI and their levels of Wnt5a were consistently higher than those in the improving AKI (Table 1). The association between Wnt5a values and worsening AKI persisted after the adjustment for age, sex, baseline serum Cr, and disease severity (P=0.044, 0.005, and 0.001, at respect time point). Elevated Wnt5a level was related to the raising risk of MAKE (P=0.119 on day 1, 0.060 on day 5, and 0.039 on discharge day), increased RRT needs or 30-day death (P=0.109, 0.003, and 0.004, respectively). (Fig 1). This study identified the patterns that high Wnt5a values on discharge day was associated with unrecovered AKI, irrespective of the confounders. The trajectory of Wnt5a over time differed according to the pattern and discharge renal function (P=0.004 and 0.003). Conclusion: Wnt5a measurment may serve as a valuable biomarker for identifying at-risk individuals with urosepsis.The adjusted likelyhood of Wnt5a for each component in urosepsis patients. Baseline Wnt5a values - Wnt5a, ng/mL Improving AKI (N=58) Persistent or worsening AKI (N=29) P value On day 1 2.0 (1.8, 2.3) 2.3 (2.0, 2.6) 0.012 On day 5 1.9 (1.7, 2.3) 2.3 (1.9, 2.7) 0.009 On discharge day 2.0 (1.7, 2.3) 2.5 (2.1, 2.7) 0.001 Data are expressed as median (interquartile range).