P-Selectin, Vascular Endothelial Cadherin, and Vascular Cell Adhesion Molecule-1 as Novel Biomarkers for ABO Hemolytic Disease of the Fetus and Newborn.

Objective: This study aims to assess the potential of vascular endothelial injury markers, namely, P-selectin (PS), vascular endothelial cadherin (VE-Cad), and vascular cell adhesion molecule-1 (VCAM-1), as diagnostic and prognostic biomarkers for ABO hemolytic disease of the fetus and newborn (HDFN). Methods: A total of 218 pregnant women with ABO blood group incompatibility were recruited from the Third People's Hospital of Bengbu Affiliated to Bengbu Medical University. The serum levels of PS, VCAM-1, and VE-Cad were measured, and the participants were followed up until postpartum. The women were divided into an HDFN group and a control group based on the occurrence of ABO-HDFN. The correlations between the three vascular endothelial injury markers, pregnant anti-A/B antibody titers, and the occurrence and severity of HDFN were analyzed. Results: Compared to the control group, the levels of PS, VCAM-1, and VE-Cad were significantly elevated in the HDFN group. Additionally, these markers increased with higher IgG anti-A/B titers. For diagnosing HDFN, the area under the curve (AUC) for PS, VCAM-1, and VE-Cad were 0.826, 0.765, and 0.799, respectively. Moreover, the combined AUC of the three markers with IgG anti-A/B titers was 0.9. The levels of the three biomarkers were significantly negatively correlated with neonatal hemoglobin (Hb) and significantly positively correlated with reticulocyte percentage (Ret%), indirect bilirubin (IBIL), and lactate dehydrogenase (LDH). Univariate logistic regression indicated that increased levels of PS, VCAM-1, and VE-Cad were associated with a higher probability of ABO-HDFN. Multivariate logistic regression revealed that PS is an independent positive factor for HDFN. Conclusion: PS, VCAM-1, and VE-Cad provide experimental evidence for prenatal screening, diagnosis, early prevention and treatment of ABO-HDFN.