{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:04:11Z","timestamp":1784624651440,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":201,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mediators of Inflammation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients receiving massive transfusion after acute hemorrhage are at risk for transfusion\u2010related acute lung injury (TRALI), a severe complication. Neutrophil extracellular traps (NETs) play a key role in acute lung injury. This study aimed to explore the link between NETs and TRALI and to develop a risk\u2010prediction model using machine learning for early detection and intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicenter prospective study, 513 patients with acute massive hemorrhage who underwent transfusion therapy (March 2020\u2013February 2025) were consecutively recruited. All biomarker assays, sampling time points, and the statistical analysis plan were prespecified and ethically approved before study initiation. Based on TRALI occurrence after transfusion, they were divided into an injured group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200942) and a uninjured group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009471). Clinical features and NET\u2010related markers were compared. LASSO regression was used for variable selection, followed by random forest for importance ranking. Multivariate logistic regression identified independent predictors, and a nomogram model was built and evaluated using ROC analysis, calibration, and decision curve analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The injured group had significantly higher rates of smoking history, total infusion volume, perioperative transfusion volume, and transfusion frequency (all\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Levels of citrullinated histone H3 (citH3), myeloperoxidase (MPO), neutrophil elastase (NE), interleukin\u20106 (IL\u20106), interleukin\u20101\n                      <jats:italic>\u03b2<\/jats:italic>\n                      (IL\u20101\n                      <jats:italic>\u03b2<\/jats:italic>\n                      ), tumor necrosis factor\u2010\n                      <jats:italic>\u03b1<\/jats:italic>\n                      (TNF\u2010\n                      <jats:italic>\u03b1<\/jats:italic>\n                      ), and interleukin\u20108 (IL\u20108) were also elevated (all\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). LASSO identified seven key variables, with citH3 and MPO showing high importance. Multivariate analysis confirmed citH3 (OR\u2009=\u20091.142), MPO (OR\u2009=\u20095.017), and NE (OR\u2009=\u20091.014) as independent predictors of TRALI (all\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). The combined model achieved an AUC of 0.85 (95% CI: 0.78\u20130.92), indicating strong predictive performance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TRALI risk in acute massive hemorrhage patients is associated with NET\u2010related markers, particularly citH3, MPO, and NE. A model integrating these indicators provides valuable early identification of TRALI, aiding clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/mi\/7778073","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:32:32Z","timestamp":1784622752000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a Predictive Model for Transfusion\u2010Related Acute Lung Injury Based on Neutrophil Extracellular Traps (NETs)"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4798-7493","authenticated-orcid":false,"given":"Qiong","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2640-1617","authenticated-orcid":false,"given":"Zhenyang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9907-8454","authenticated-orcid":false,"given":"Junliang","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2202-0984","authenticated-orcid":false,"given":"Xinchen","family":"Qiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9574-3336","authenticated-orcid":false,"given":"Wen","family":"Gong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0141-4252","authenticated-orcid":false,"given":"Lingling","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9699-8535","authenticated-orcid":false,"given":"Huaying","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4295-6288","authenticated-orcid":false,"given":"Zhen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8559-8114","authenticated-orcid":false,"given":"Junfang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"crossref","DOI":"10.1172\/jci.insight.157342","article-title":"Disulfiram Inhibits Neutrophil Extracellular Trap Formation and Protects Rodents From Acute Lung Injury and SARS-CoV-2 Infection","volume":"7","author":"Adrover J. M.","year":"2022","journal-title":"JCI Insight"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2024028012"},{"key":"e_1_2_13_3_2","first-page":"465","article-title":"Human Neutrophil antigen 3 genotype Impacts Neutrophil-Mediated Endothelial Cell Cytotoxicity in a Two-Event Model of TRALI","volume":"20","author":"Chiaretti S.","year":"2022","journal-title":"Blood Transfusion"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-024-09809-9"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acpath.2022.100022"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2024.117456"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/jvim.17175"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/vox.13684"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.8284"},{"key":"e_1_2_13_10_2","article-title":"Chronicle of Hypoxemia: Transfusion-Associated Circulatory Overload Versus Transfusion-Related Acute Lung Injury","volume":"14","author":"Jha S.","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_13_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2024.2436972"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/trf.18229"},{"key":"e_1_2_13_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000005505"},{"key":"e_1_2_13_14_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.00040.2023"},{"key":"e_1_2_13_15_2","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2025.46.8.20250233"},{"key":"e_1_2_13_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2022.104004"},{"key":"e_1_2_13_17_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1324021"},{"key":"e_1_2_13_18_2","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2024-261488","article-title":"Transfusion-Related Acute Lung Injury\/Transfusion-Associated Circulatory Overload in a Child With Non-Transfusion Dependent Thalassemia and Aplastic Crisis due to Acute Parvovirus B19 Infection","volume":"17","author":"Mantadakis E.","year":"2024","journal-title":"BMJ Case Reports"},{"key":"e_1_2_13_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2024.103970"},{"key":"e_1_2_13_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000002080"},{"key":"e_1_2_13_21_2","article-title":"Transfusion-Related Acute Lung Injury (TRALI) in Postoperative Anesthesia Care Unit (PACU) After One Unit of Platelets: A Case Report","volume":"14","author":"Perez-Viloria M. E.","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_13_22_2","first-page":"443","article-title":"Understanding Transfusion-Related Acute Lung Injury (TRALI) and Its Complex Pathophysiology","volume":"20","author":"van Wonderen S. F.","year":"2022","journal-title":"Blood Transfus"},{"key":"e_1_2_13_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/vox.13402"},{"key":"e_1_2_13_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tracli.2022.03.005"},{"key":"e_1_2_13_25_2","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1182\/blood.2025028794","article-title":"Mitochondrial DNA via Recipient TLR9 Acts as a Potent First-Hit in Murine Transfusion-Related Acute Lung Injury (TRALI)","volume":"146","author":"Rebetz J.","year":"2025","journal-title":"Blood"},{"key":"e_1_2_13_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/trf.17688"},{"key":"e_1_2_13_27_2","first-page":"454","article-title":"Transfusion-Related Acute Lung Injury (TRALI): A Retrospective Review of Reported Cases in Queensland, Australia Over 20 years","volume":"20","author":"Sivakaankthan A.","year":"2022","journal-title":"Blood Transfusion"},{"key":"e_1_2_13_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2021.100926"},{"key":"e_1_2_13_29_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023020484"}],"container-title":["Mediators of Inflammation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/mi\/7778073","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/mi\/7778073","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/mi\/7778073","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:32:34Z","timestamp":1784622754000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/mi\/7778073"}},"subtitle":[],"editor":[{"given":"Sandra Helena Penha","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/mi\/7778073"],"URL":"https:\/\/doi.org\/10.1155\/mi\/7778073","archive":["Portico"],"relation":{},"ISSN":["0962-9351","1466-1861"],"issn-type":[{"value":"0962-9351","type":"print"},{"value":"1466-1861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-02-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"7778073"}}