Predictive value of plasma thrombomodulin,t-PAIC,and D-dimer for acute kidney injury risk during red blood cell transfusion in AML patients

Feng Nina; Yang Qinqin; Li Qian; Zhang Rui; Qu Wenjing; Zhao Miaomiao; Zhang Li

doi:10.11986/j.issn.1673-873X.2025.04.15

Abstract：Objective To explore the predictive value of plasma thrombomodulin(TM),tissuetype plasminogen activator-plas-minogen activator inhibitor complex(t-PAIC),and D-dimer(DD)for the risk of acute kidney injury(AKI)during red blood cell(RBC)transfusion in patients with acute myeloid leukemia(AML),with a view to informing early intervention and indi-vidualized transfusion strategies.Methods From July 2023 to June 2024,105 AML patients undergoing RBC transfusion at Yan'an People's Hospital were enrolled as the observation group,alongside 100 healthy individuals undergoing routine exami-nation as controls.AML patients were allocated to those who developed AKI(n=26)and those who did not(n=79).Plasma TM,t-PAIC,and DD levels were measured and compared between groups.Baseline clinical data were compared,and stepwise logistic regression was adopted to identify factors associated with AKI during transfusion.Receiver operating characteristic(ROC)curves were constructed to assess the predictive performance of TM,t-PAIC,and DD.Results Compared with the control group,plasma TM,t-PAIC and DD in the observation group were significantly increased(P<0.05).The AKI inci-dence during transfusion among AML patients was 24.76%(26/105).There were no significant differences between AKI and nonAKI groups in sex distribution,age,red or white blood cell counts,coagulation times,hemoglobin,fibrinogen,blood urea nitrogen,serum creatinine,or β2microglobulin(P>0.05).However,the AKI group received more transfusion episodes,had a higher proportion receiving≥10 U of RBCs,higher plasma TM and t-PAIC and DD leves,compared with the nonAKI group(P<0.05).Stepwise regression analysis demonstrated that increased transfusion episodes(OR=1.763;95%CI:1.116-2.785),elevated TM(OR=2.083;95%CI:1.358-3.196),elevated t-PAIC(OR=1.684;95%CI:1.119-2.535),ele-vated DD(OR=2.236;95%CI:1.458-3.429)were risk factors for AKI occurrence of AML patients receiving RBC trans-fusion(P<0.05).ROC analysis indicated that combined measurement of TM,t-PAIC,and DD predicted AKI risk better than any single marker for AML patients during RBC transfusion(P<0.001).Conclusion Elevated plasma TM,t-PAIC and DD levels are independent risk factors of AKI during RBC transfusion in AML patients.Detection of these markers before clini-cal treatment can guide preventive measures to reduce early AKI risk.