TY - JOUR
TI - Rotational Thromboelastometry in Neonates Admitted to a Neonatal
Intensive Care Unit: A Large Cross-sectional Study
AU - Sokou, Rozeta
AU - Tsantes, Andreas G.
AU - Konstantinidi, Aikaterini and
AU - Ioakeimidis, Georgios
AU - Lampridou, Maria
AU - Parastatidou, Stavroula
AU - and Theodoraki, Martha
AU - Piovani, Daniele
AU - Iliodromiti, Zoe and
AU - Boutsikou, Theodora
AU - Iacovidou, Nicoletta
AU - Douramani, Panagiota
AU - and Poulis, Aristarchos
AU - Kokoris, Styliani
AU - Kriebardis, Anastasios
AU - G.
AU - Bonovas, Stefanos
AU - Tsantes, Argirios E.
JO - Seminars in Thrombosis and Hemostasis
PY - 2021
VL - 47
TODO - 07
SP - 875-884
PB - THIEME MEDICAL PUBL INC
SN - 0094-6176, 1098-9064
TODO - 10.1055/s-0041-1729964
TODO - thromboelastometry; ROTEM; prognosis; mortality; critically ill neonates
TODO - The aim of the present study was to assess the coagulation profile in
neonatal critical illness using rotational thromboelastometry (ROTEM),
and to investigate its association with disease severity and its
potential prognostic role in this clinical setting. Over a period of 67
months (July 2014-February 2020) 423 critically ill neonates with
confirmed or suspected sepsis, perinatal hypoxia, or respiratory
distress syndrome, hospitalized in our neonatal intensive care unit were
included in the study. Demographic, clinical, and laboratory data were
recorded on admission day and arterial blood was analyzed on ROTEM
analyzer using the standard extrinsically activated rotational
thromboelastometry assay (EXTEM). Neonatal illness severity scores
(Modified NEOMOD [Neonatal Multiple Organ Dysfunction] and SNAPPE
[Score for Neonatal Acute Physiology with Perinatal Extension]) were
calculated at the same time as ROTEM analysis. Mortality during
in-hospital stay was the main outcome measure. Multivariable analyses
showed that a 10mm decrease in EXTEM clot amplitude recorded at
10minutes (A10) is significantly associated with a higher mortality
(odds ratio [OR]=1.69, 95% confidence interval [CI]: 1.33-2.08).
Higher modified NEOMOD (OR=1.36, 95% CI: 1.26-1.47) and higher SNAPPE
scores (OR=1.06, 95% CI: 1.04-1.08) were also associated with increased
mortality. The CT and A10 variables demonstrated the best prognostic
performance among the EXTEM parameters for mortality (area under the
curve [AUC]=0.78; 95% CI: 0.69-0.86 and AUC=0.76; 95% CI: 0.66-0.85,
respectively), showing an optimal cut-off CT >= 63seconds and A10 <=
37mm. Using optimal cut-off values of the EXTEM parameters for
prediction of mortality, neonates with CT >= 63seconds were 7.4 times
more likely to die (OR=7.40, 95% CI: 3.50-15.65), while neonates with
A10 <= 37mm were 5.8 times more likely to die (OR=5.88, 95% CI:
2.94-12.50). An EXTEM hypocoagulable profile on disease onset was shown
to be an independent risk factor for in-hospital mortality in neonatal
critical illness.
ER -