Construction of a Predictive Model for High-Risk ISS Stage in Newly Diagnosed Multiple Myeloma Patients Based on Coagulation Indicators

Ruicheng LI; Huarong JING; Yin WU; Ziqi LIN; Peipei ZHAO; Shan WEI; Tian WANG

Article Contents

Article Navigation > Journal of Kunming Medical University > 2025 > Accepted Manuscript

Ruicheng LI, Huarong JING, Yin WU, Ziqi LIN, Peipei ZHAO, Shan WEI, Tian WANG. Construction of a Predictive Model for High-Risk ISS Stage in Newly Diagnosed Multiple Myeloma Patients Based on Coagulation Indicators[J]. Journal of Kunming Medical University.

Citation:

PDF( 891 KB)

Construction of a Predictive Model for High-Risk ISS Stage in Newly Diagnosed Multiple Myeloma Patients Based on Coagulation Indicators

Department of Clinical Laboratory，Tangdu Hospital，Air Force Medical University，Xi’an Shaanxi 710038，China

Abstract

Abstract

Objectives To investigate the correlation between coagulation function indicators and International Staging System （ISS） staging in newly diagnosed multiple myeloma （NDMM） patients, and to establish a predictive model for ISS high-risk staging based on coagulation indicators. Methods A total of 114 NDMM patients from May 2021 to December 2024 were collected as the model development cohort and randomly divided into training set （80 cases） and internal validation set （34 cases） at a ratio of 7∶3; 52 patients from January to June 2025 were collected as external validation cohort. Patients were stratified into stage I/II group and stage III group according to ISS staging, and differences in coagulation function indicators between the two groups were compared. Spearman correlation analysis was used to evaluate the correlations between coagulation indicators and β2-microglobulin （β2-MG） and albumin （ALB）. Binary logistic regression was employed to identify independent risk factors for ISS high-risk staging, and a nomogram prediction model was constructed to assess its predictive performance. Results In ISS stage III patients, levels of prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB）, thrombin time （TT）, and thrombomodulin （TM） were all significantly higher than those in ISS stage I/II patients （all P < 0.05）. Correlation analysis showed that all five coagulation function indicators were positively correlated with β₂-microglobulin, while PT, APTT, and TT were negatively correlated with albumin. Multivariate logistic regression analysis revealed that PT, TT, and TM were independent risk factors for ISS high-risk staging. The nomogram prediction model based on PT, TT, and TM showed an AUC of 0.849, with sensitivity of 90.6% and specificity of 67.6%. Conclusions PT, TT, and TM are closely associated with ISS staging and can serve as independent risk factors for high-risk staging.
- Multiple myeloma,
- Coagulation function,
- International staging system,
- Predictive model,
- Correlation

FullText(HTML)

References(20)

References

[1]	Rajkumar S V. Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management[J]. American J Hematol, 2024, 99(9): 1802-1824. doi: 10.1002/ajh.27422
[2]	D’Agostino M, Cairns D A, Lahuerta J J, et al. Second revision of the international staging system (R2-ISS) for overall survival in multiple myeloma: A European myeloma network (EMN) report within the HARMONY project[J]. J Clin Oncol, 2022, 40(29): 3406-3418. doi: 10.1200/JCO.21.02614
[3]	Ghansah H, Debreceni I B, Váróczy L, et al. Patients with multiple myeloma and monoclonal gammopathy of undetermined significance have variably increased thrombin generation and different sensitivity to the anticoagulant effect of activated protein C[J]. Thromb Res, 2023, 223(3): 44-52.
[4]	Papageorgiou L, Alhaj Hussen K, Thouroude S, et al. Modelization of blood-borne hypercoagulability in myeloma: A tissue-factor-bearing microparticle-driven process[J]. TH Open, 2019, 3(4): e340-e347. doi: 10.1055/s-0039-1700885
[5]	Huang Y, Wang C, Wang H, et al. Rediscovering hemostasis abnormalities in multiple myeloma: The new era[J]. Heliyon, 2024, 10(13): 1-14.
[6]	Rajkumar S V, Dimopoulos M A, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma[J]. Lancet Oncol, 2014, 15(12): e538-e548. doi: 10.1016/S1470-2045(14)70442-5
[7]	中国医师协会血液科医师分会, 中华医学会血液学分会. 中国多发性骨髓瘤诊治指南(2022年修订)[J]. 中华内科杂志, 2022, 61(5): 480-487.
[8]	Wang J H, Xiang P, Zhao E J, et al. Impact of type 2 and steroid-Induced diabetes mellitus on prognosis in patients with multiple myeloma[J]. World J Surg Oncol, 2025, 23(1): 1-10. doi: 10.1186/s12957-024-03642-9
[9]	Mohan Lal B, Rhee F V, Al Hadidi S. Current state of evidence on definitions and management of high-risk multiple myeloma[J]. Curr Oncol Rep, 2025, 27(3): 258-277. doi: 10.1007/s11912-025-01639-5
[10]	Hu M, Ma Y, Jia K, et al. Analysis of coagulation alteration and its correlation with β2-microglobulin in 371 patients with newly diagnosed multiple myeloma[J]. Hematology, 2024, 29(1): 1-8.
[11]	Martini F, Cecconi N, Paolicchi A, et al. Interference of monoclonal gammopathy with fibrinogen assay producing spurious dysfibrinogenemia[J]. TH Open, 2019, 3(1): e64-e66. doi: 10.1055/s-0039-1683969
[12]	Geng C, Yang G, Wang H, et al. The prognostic role of prothrombin time and activated partial thromboplastin time in patients with newly diagnosed multiple myeloma[J]. Biomed Res Int, 2021, 2021(5): 1-9.
[13]	Melaccio A, Reale A, Saltarella I, et al. Pathways of angiogenic and inflammatory cytokines in multiple myeloma: Role in plasma cell clonal expansion and drug resistance[J]. J Clin Med, 2022, 11(21): 1-20.
[14]	Zhang T, Lin Z, Zheng Z, et al. Prognostic significance of β2-microglobulin decline index in multiple myeloma[J]. Front Oncol, 2024, 14(3): 1-10.
[15]	Cai Y, Zhao Y, Dai Q, et al. Prognostic value of the albumin-globulin ratio and albumin-globulin score in patients with multiple myeloma[J]. J Int Med Res, 2021, 49(3): 1-12.
[16]	Carlisi M, Lo Presti R, Mancuso S, et al. Calculated whole blood viscosity and albumin/fibrinogen ratio in patients with a new diagnosis of multiple myeloma: Relationships with some prognostic predictors[J]. Biomedicines, 2023, 11(3): 1-11.
[17]	Shen H, Wu C, Chen L, et al. Acquired heparin-like anticoagulation process in a patient with multiple myeloma: A case report and literature review[J]. Transl Cancer Res, 2020, 9(11): 7366-7371. doi: 10.21037/tcr-20-1968
[18]	Pandey S, Post S R, Alapat D V, et al. Prolonged prothrombin time correlates with serum monoclonal protein concentration in patients with plasma cell dyscrasia[J]. Int J Lab Hematol, 2013, 35(4): 421-427. doi: 10.1111/ijlh.12036
[19]	Zaharia A L, Tutunaru D, Oprea V D, et al. Thrombomodulin serum levels-a predictable biomarker for the acute onset of ischemic stroke[J]. Curr Issues Mol Biol, 2024, 46(1): 677-688. doi: 10.3390/cimb46010044
[20]	Liu L, Qu J, Dai Y, et al. An interactive nomogram based on clinical and molecular signatures to predict prognosis in multiple myeloma patients[J]. Aging, 2021, 13(14): 18442-18463. doi: 10.18632/aging.203294

Relative Articles(20)

Relative Articles

[1]	Yuanzhen WANG, Hongyan WEI, Renhai TIAN, Yongzhen Chen, Danqing XU, Yingyuan ZHANG, Lixian CHANG, Chunyun LIU, Li LIU. Establishment and Evaluation of a Risk Prediction Model for Chronic Liver Failure Complicated by Primary Hepatocellular Carcinoma Before Intervention. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250321
[2]	Yan CHI, Junxian LI, Ling ZHAO, Wenyi LI, Tingyu KE. Correlation Analysis between Coagulation and Fibrinolysis in Early Pregnancy and Gestational Diabetes in Women with Different BMI before Pregnancy. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250410
[3]	Dongyan LIU, Yan LIU, Zhiming REN, Feng WANG, Yong WANG. Analysis of Risk Factors for Chemotherapy Induced Myelosuppression and Construction of Prediction Models for Myelosuppression Based on Logistic Regression Analysis in Cancer Patients. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250815
[4]	Yanfen MA, Sasa LIU, Jian HU, Depei CAI, Yongfeng QIAO, Xiaoqin WANG. Analysis of the Predictive Effects of Lipid Metabolism and Liver Function Indicators on Prediabetes. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20241222
[5]	Zhixin NIU, Lihua TANG, Lei SHI, Chao HONG, Yufeng YAO, Zhiling YAN. Correlation of MAPK1 and NRAS Gene Polymorphisms with Cervical Intraepithelial Neoplasia in Yunnan Han Population. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240502
[6]	Yanmei JI, Wenjun LI, Qingyun LI, Ni GUO, Ni MENG, Dan ZHOU, Qiuyu LI, Xingfang JIN. The Analysis of Related Factors of Cognitive Impairment after the Acute Ischemic Stroke and Construction of Nomogram Model. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240511
[7]	, . . Journal of Kunming Medical University,
[8]	Xiaohua LU, Hongxin YUAN. The Analysis of the Correlation between BTLA，CTLA-4 Gene Polymorphisms and the Efficacy and Prognosis of TACE Combined Targeted Therapy for Liver Cancer. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230927
[9]	Jianmei LI, Yanling JIN. Efficacy and Safety of Bortezomib，Lenalidomide Combined with Dexamethasone in the Treatment of Multiple Myeloma. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230610
[10]	Guimei ZHANG, Shu CHEN, Yunhua SONG, Yang WU, Hongyuan ZHOU. Risk Factors of Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Establishment of Risk Prediction Model. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20220830
[11]	Xin WU, Yun LI, Pin-fei ZOU, Mei-ling LI, Yong-bin PU. The Detection Rate of Musculoskeletal Ultrasound in Patients with Rheumatic Knee Arthritis and Its Correlation with Knee Function. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210814
[12]	Lin ZHANG, Yan-ying LI, Qi MENG, Can-hui LI, Yun SHEN, Hong-yan BI, Qiu-ping YANG, Yue XIONG. Correlation of Platelet Function，Coagulation and Fibrinolytic System Function in Elderly Patients with Type 2 Diabetes. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20211110
[13]	Cao Hong Hua , Wu Na , He Ming , Zhang Rui , Zhou Ye Ying , Lai Xuan , Shen Zheng Lei . . Journal of Kunming Medical University,
[14]	Wang Xue Jiao , Zhang Zhe , Yu Jing Xing , Li Yuan Yuan , Zhao Mei Shu , Yin Lie Fen . Mutiple Myeloma with Double Clones of IgD-λ+λ:Two Cases Report. Journal of Kunming Medical University,
[15]	He Hong Fen . Clinical Observation of the Changes of Blood Coagulation in Patients after Gynecological Tumor Surgery. Journal of Kunming Medical University,
[16]	Yang Xiao Ling . . Journal of Kunming Medical University,
[17]	Ji Hong . . Journal of Kunming Medical University,
[18]	Li Wei Hua . . Journal of Kunming Medical University,
[19]	Wan Yun Yan . . Journal of Kunming Medical University,
[20]	He Zhen Xin . . Journal of Kunming Medical University,