Τίτλος:
Rotational Thromboelastometry in Neonates Admitted to a Neonatal
Intensive Care Unit: A Large Cross-sectional Study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Sokou, Rozeta
Tsantes, Andreas G.
Konstantinidi, Aikaterini and
Ioakeimidis, Georgios
Lampridou, Maria
Parastatidou, Stavroula
and Theodoraki, Martha
Piovani, Daniele
Iliodromiti, Zoe and
Boutsikou, Theodora
Iacovidou, Nicoletta
Douramani, Panagiota
and Poulis, Aristarchos
Kokoris, Styliani
Kriebardis, Anastasios
G.
Bonovas, Stefanos
Tsantes, Argirios E.
Περιοδικό:
Seminars in Thrombosis and Hemostasis
Εκδότης:
THIEME MEDICAL PUBL INC
Λέξεις-κλειδιά:
thromboelastometry; ROTEM; prognosis; mortality; critically ill neonates
DOI:
10.1055/s-0041-1729964
