Association of serum IL-1, PAF and poor prognosis in patients with acute massive hemorrhage complicated by transfusion-related acute lung injury

doi:10.3877/cma.j.issn.2095-5820.2026.02.007

Abstract

Abstract:

Objective

To investigate the association of serum interleukin-1 (IL-1), platelet activating factor (PAF), and poor prognosis in patients with acute massive hemorrhage complicated with transfusion-related acute lung injury (TRALI).

Methods

Clinical data of 108 patients with acute massive hemorrhage complicated with TRALI treated at the Tianmen First People's Hospital and Jingmen People's Hospital from June 2021 to August 2024 were retrospectively collected. Based on survival status within 7 days after TRALI, patients were divided into a good prognosis group (88 cases, 81.48%) and a poor prognosis group (20 cases, 18.52%). The levels of serum IL-1 and PAF detected at the time of diagnosis of TRALI were collected. The relationship between the levels of serum IL-1 and PAF and the poor prognosis of patients with acute massive hemorrhage complicated with TRALI were explored through statistical methods such as t-test, receiver operating characteristic curve (ROC curve), logistic regression analysis, and interaction.

Results

The proportion of patients with a history of blood transfusion and smoking in the poor prognosis group was significantly higher than that in the good prognosis group(P＜0.05). The serum levels of IL-1 and PAF in the poor prognosis group were higher than those in the good prognosis group(P＜0.05). Logistic regression analysis showed that after adjusting for confounding factors, serum IL-1 and PAF remained poor prognostic factors in acute massive hemorrhage complicated with TRALI (P＜0.05). The ROC curves were plotted, indicating that the area under the curve (AUC) values of serum IL-1 alone and PAF in combination for predicting poor prognosis in patients with acute massive hemorrhage complicated with TRALI were 0.774, 0.824, and 0.891, respectively. The combined prediction had the highest value, among which the cutoff value of serum IL-1 was 111.900 pg/ml. The cut-off value of PAF was 99.950 μg/L. Serum IL-1 and PAF had a positive interaction effect on poor prognosis in patients with acute massive hemorrhage complicated with TRALI. When both of them were highly expressed, the risk of poor prognosis was 53.200 times and 43.908 times higher than that when both of them were low expressed and other location factors, respectively. The synergistic effect was 6.300 times greater than the sum of the effect of the two alone. Among the co-occurrence risks, 82.53% were caused by their interaction.

Conclusions

There is a close correlation between serum IL-1 and PAF levels and poor prognosis in patients with acute hemorrhage complicated with TRALI. When serum IL-1 levels are greater than 111.900 pg/ml and PAF levels are greater than 99.950 μg/L, the risk of poor prognosis in patients with acute hemorrhage complicated with TRALI is higher.

Key words: acute massive hemorrhage, transfusion related acute lung injury, interleukin-1, platelet activating factor, prognosis

Jian Xiang, Li Liu. Association of serum IL-1, PAF and poor prognosis in patients with acute massive hemorrhage complicated by transfusion-related acute lung injury[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2026, 14(02): 134-140.

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Figures/Tables 5

临床资料	预后良好组（n=88）	预后不良组（n=20）	t/χ²值	P值
年龄/岁，（ $x ¯$ ±s）	41.12±7.47	40.98±7.54	0.076	0.940
性别/n（%）			0.246	0.620
男	45.00（51.14）	9.00（45.00）
女	43.00（48.86）	11.00（55.00）
体质量指数/（kg/m²），（ $x ¯$ ±s）	23.54±1.87	23.19±1.91	0.066	0.947
既往输血史/n（%）			4.116	0.042
有	20.00（22.73）	9.00（45.00）
无	68.00（77.27）	11.00（55.00）
吸烟史/n（%）			4.440	0.035
有	14.00（15.91）	8.00（40.00）
无	74.00（84.09）	12.00（60.00）
饮酒史/n（%）			0.327	0.567
有	21.00（23.86）	6.00（30.00）
无	67.00（76.14）	14.00（70.00）
高血压/n（%）			0.021	0.884
有	18.00（20.45）	5.00（25.00）
无	70.00（79.55）	15.00（75.00）
糖尿病/n（%）			0.050	0.806
有	24.00（27.27）	6.00（30.00）
无	64.00（72.73）	14.00（70.00）
高脂血症/n（%）			0.057	0.811
有	13.00（14.77）	4.00（20.00）
无	75.00（85.23）	16.00（80.00）
大出血原因/n（%）			0.124	0.725
创伤性	23.00（26.14）	6.00（30.00）
非创伤性	65.00（73.86）	14.00（70.00）
输血开始至TRALI发生时间/h，（ $x ¯$ ±s）	5.41±1.71	5.36±1.67	0.119	0.906
血制品类型/n（%）			0.032	0.984
新鲜冰冻血浆	37.00（42.05）	8.00（40.00）
冷沉淀	25.00（28.41）	6.00（30.00）
机采血小板	26.00（29.55）	6.00（30.00）
输血量/ml，（ $x ¯$ ±s）	1713.65±301.23	1727.76±289.65	0.190	0.849
是否接受机械通气治疗/n（%）			0.001	0.992
是	73.00（82.95）	16.00（80.00）
否	15.00（17.05）	4.00（20.00）
IL-1/pg/ml	107.65±12.13	121.25±11.87	4.546	＜0.001
PAF/μg/L	93.32±11.63	108.76±10.98	5.413	＜0.001

临床资料	预后良好组（n=88）	预后不良组（n=20）	t/χ²值	P值
年龄/岁，（ $x ¯$ ±s）	41.12±7.47	40.98±7.54	0.076	0.940
性别/n（%）			0.246	0.620
男	45.00（51.14）	9.00（45.00）
女	43.00（48.86）	11.00（55.00）
体质量指数/（kg/m²），（ $x ¯$ ±s）	23.54±1.87	23.19±1.91	0.066	0.947
既往输血史/n（%）			4.116	0.042
有	20.00（22.73）	9.00（45.00）
无	68.00（77.27）	11.00（55.00）
吸烟史/n（%）			4.440	0.035
有	14.00（15.91）	8.00（40.00）
无	74.00（84.09）	12.00（60.00）
饮酒史/n（%）			0.327	0.567
有	21.00（23.86）	6.00（30.00）
无	67.00（76.14）	14.00（70.00）
高血压/n（%）			0.021	0.884
有	18.00（20.45）	5.00（25.00）
无	70.00（79.55）	15.00（75.00）
糖尿病/n（%）			0.050	0.806
有	24.00（27.27）	6.00（30.00）
无	64.00（72.73）	14.00（70.00）
高脂血症/n（%）			0.057	0.811
有	13.00（14.77）	4.00（20.00）
无	75.00（85.23）	16.00（80.00）
大出血原因/n（%）			0.124	0.725
创伤性	23.00（26.14）	6.00（30.00）
非创伤性	65.00（73.86）	14.00（70.00）
输血开始至TRALI发生时间/h，（ $x ¯$ ±s）	5.41±1.71	5.36±1.67	0.119	0.906
血制品类型/n（%）			0.032	0.984
新鲜冰冻血浆	37.00（42.05）	8.00（40.00）
冷沉淀	25.00（28.41）	6.00（30.00）
机采血小板	26.00（29.55）	6.00（30.00）
输血量/ml，（ $x ¯$ ±s）	1713.65±301.23	1727.76±289.65	0.190	0.849
是否接受机械通气治疗/n（%）			0.001	0.992
是	73.00（82.95）	16.00（80.00）
否	15.00（17.05）	4.00（20.00）
IL-1/pg/ml	107.65±12.13	121.25±11.87	4.546	＜0.001
PAF/μg/L	93.32±11.63	108.76±10.98	5.413	＜0.001

因素	logistic回归分析结果						多重共线性检验
因素	B值	SE值	Wald值	P值	OR值	95%CI	容差	VIF值
既往输血史	1.692	0.783	4.671	0.031	5.431	1.171~25.199	0.921	1.086
吸烟史	2.136	0.934	5.226	0.022	8.468	1.356~52.871	0.938	1.066
IL-1	0.086	0.033	7.034	0.008	1.090	1.023~1.162	0.973	1.028
PAF	0.149	0.041	13.593	＜0.001	1.161	1.073~1.257	0.944	1.059
常量	-27.698	6.070	20.822	＜0.001	-	-	-	-

指标	AUC	AUC的95%CI	P值	cut-off值	敏感度	特异度	约登指数
IL-1	0.774	0.664~0.884	＜0.001	111.900 pg/ml	0.800	0.614	0.414
PAF	0.824	0.730~0.919	＜0.001	99.950 μg/L	0.850	0.705	0.555
联合预测	0.891	0.805~0.977	＜0.001	-	0.800	0.864	0.644

变量	变量		OR值	OR 95%CI		RERI值	ARR值	SI值
变量	预后良好	预后不良	OR值	下限	上限	RERI值	ARR值	SI值
IL-1/PAF						43.908	82.53%	6.300
-/-	38	1	1.000	-	-
+/-	24	2	3.167	0.272	36.853
-/+	16	3	7.125	0.688	73.769
+/+	10	14	53.200	6.228	454.443

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