A prospective Study of Urinary Dickkopf 3 as a Novel Biomarker for Cardiorenal Syndrome in Sepsis

Background: Cardiorenal syndrome (CRS) refers to primary dysfunction of either the heart or kidneys, which subsequently causes secondary injury to the other organ. Sepsis, redefined in 2016 as a dysregulated immune response to infection resulting in life-threatening organ damage, is one of the main triggers of CRS. This study investigated urinary Dickkopf-3 (DKK3) as a potential biomarker for CRS in septic patients. Methods: A prospective cohort study was conducted on 108 critically ill septic patients admitted to the Intensive Care Unit, All patients underwent thorough clinical assessment, echocardiography, and laboratory investigations including CBC, KFT,LFT, CRP, ESR, and procalcitonin. Urinary DKK3 levels were measured using enzyme-linked immunosorbent assay . Patients were followed for ICU outcomes, including length of stay, need for mechanical ventilation, dialysis, and mortality. Results:. A statistically significant positive correlation was observed between urinary DKK3 levels (ng/ml) and CRP, ESR, WBC count, procalcitonin, serum creatinine, urea, duration of ICU stay. Furthermore, a significant inverse correlation was found between urinary DKK3 levels and hemoglobin, platelet count, and ejection fraction, whereas no association with age was detected. There were highly statistically significant difference between Urinary DKK3 level (ng/ml) and need of ventilation, need of dialysis and mortality. Conclusions: Urinary DKK3 may be a useful biomarker for early detection and prognostic factor of acute kidney injury in septic cardiorenal syndrome. It could serve as an early indicator for adverse ICU outcomes, including the need for mechanical ventilation, hemodialysis, and increased risk of mortality in those category of patients.