Fig. 7: Detection of CD35-uEV enables early diagnosis and prognosis of subclinical AKI.

A Workflow for sample collection and analysis of E-AKI cohort (n = 72), with samples collected 12 h post diagnosis of sepsis, prior to a clinical diagnosis of AKI (Image was created in BioRender. Li, N. (2025) https://BioRender.com/6zj1ctq); B CD35-uEV levels were significantly reduced in subclinical AKI compared to non-AKI sepsis patients (p = 6.0E−7, Mann–Whitney U two-sided statistics); C ROC curve illustrating the predictive accuracy of CD35-uEV for subclinical AKI (AUC-ROC 0.84, 95% CI 0.74–0.94); D CD35-uEV levels decreased progressively with increasing AKI stages (Mann–Whitney U two-sided statistics (Compared in pairs), Non-AKI: n = 46, Stage1: n = 11, Stage2: n = 11, Stage3: n = 4); E ROC curve for CD35-uEV predicting AKI severity in subclinical AKI patients (AUC-ROC 0.69, 95% CI 0.49–0.89); F Significant reduction of CD35-uEV in patients progressing to persistent AKI compared to those with transient AKI (p = 0.04, Paired two-tailed t-test, Transient-AKI: n = 11, Persistent-AKI: n = 15); G ROC curve demonstrating the prediction of CD35-uEV for persistent AKI in subclinical AKI patients (AUC-ROC 0.72, 95% CI 0.52–0.92); H Logistic regression-based restricted cubic spline analysis identified CD35-uEV as an independent diagnostic factor for subclinical AKI (p < 0.001) (adjusting for age, gender, history of hypertension, diabetes, and cardiovascular disease, as well as urine output, SOFA scores, pathogen identification, and catecholamine use), the pink translucent band represents the 95% confidence interval (error bands); I Correlation (general linear regression) of CD35-uEV levels with the peak serum creatinine (Max_Scr) (r = −0.32, p = 0.008) in subclinical AKI patients post-admission. Source data are provided as a Source Data file.