Thromboelastometry and prediction of in‐hospital mortality in neonates with sepsis

Sokou, Rozeta; Tsantes, Andreas G.; Lampridou, Maria; Tsante, Konstantina A.; Houhoula, Dimitra; Piovani, Daniele; Bonovas, Stefanos; Boutsikou, Theodora; Iliodromiti, Zoi; Iacovidou, Nicoletta; Tsantes, Argirios E.; Konstantinidi, Aikaterini

doi:10.1111/ijlh.14165

Cited by 3 publications

(2 citation statements)

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“…Furthermore, perhaps because of the historical difficulty in interpretation in neonates ( 32 ), D-Dimer is neither a test routinely conducted on the NICU population nor sufficiently measured in this cohort to facilitate meaningful study (51 D-dimer measures in 22 patients among 339 coagulation tests studied). Rotational thromboelastometry, which evaluates phases of the clotting process, showed utility to identify those at the highest risk of mortality when routinely sent among a cohort of neonates with sepsis ( 33 ). As developmental normative values are being characterized, this testing may represent an additional or alternative way to measure the effectiveness of clotting in neonates with sepsis ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

The frequency and timing of sepsis-associated coagulopathy in the neonatal intensive care unit

Aziz,

Saxonhouse,

Mahesh

et al. 2024

Front. Pediatr.

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IntroductionSepsis is a common cause of morbidity and mortality in the neonatal intensive care unit (NICU). The frequency and severity of sepsis-associated coagulopathy as well as its relationship to illness severity are unclear.MethodsWe performed a single-center, retrospective, observational cohort study of all infants admitted to the University of Florida Health (UF Health), level IV NICU between January 1st 2012 to March 1st 2020 to measure the frequency of sepsis-associated coagulopathy as well as its temporal relationship to critical illness in the NICU population. All clinical data in the electronic health record were extracted and deposited into an integrated data repository that was used for this work.ResultsWe identified 225 new sepsis episodes in 216 patients. An evaluation for sepsis-associated coagulopathy was performed in 96 (43%) episodes. Gram-negative pathogen, nSOFA score at evaluation, and mortality were greater among episodes that included a coagulopathy evaluation compared with those that did not. Abnormal coagulation results were common (271/339 evaluations; 80%) and were predominantly prothrombin times. Intervention (plasma or cryoprecipitate) followed a minority (84/271; 31%) of abnormal results, occurred in 40/96 (42%) episodes that were often associated with >1 intervention (29/40; 73%), and coincided with thrombocytopenia in 37/40 (93%) and platelet transfusion in 27/40 (68%). Shapley Additive Explanations modeling demonstrated strong predictive performance for the composite outcome of death and/or treatment for coagulopathy in neonates (f1 score 0.8, area under receiver operating characteristic curve 0.83 for those with abnormal coagulation values). The three most important features influencing the composite outcome of death or treatment for coagulopathy included administration of vasoactive medications, hematologic dysfunction assessed by the maximum nSOFA platelet score, and early sepsis (≤72 h after birth).ConclusionsA coagulopathy evaluation was performed in a minority of NICU patients with sepsis and was associated with greater illness severity and mortality. Abnormal results were common but infrequently associated with intervention, and intervention was contemporaneous with thrombocytopenia. The most important feature that influenced the composite outcome of death or treatment for coagulopathy was the administration of vasoactive-inotropic medications. These data help to identify NICU patients at risk of sepsis-associated coagulopathy.

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Section: Discussionmentioning

confidence: 99%

The frequency and timing of sepsis-associated coagulopathy in the neonatal intensive care unit

Aziz,

Saxonhouse,

Mahesh

et al. 2024

Front. Pediatr.

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“…The ability of ROTEM parameters to assess disease severity in neonates has also been reported in previous studies. [68][69][70] Increased creatinine levels emerged as a prognostic factor for hemorrhage in critically ill neonates; however, it is unclear whether this relationship is causal or a result of confounding factors owing to disease severity. Studies in adults with renal insufficiency have demonstrated complex interactions between uremic toxins, vascular wall and coagulation factors, and platelets.…”

Section: Discussionmentioning

confidence: 99%

Bleeding Scoring Systems in Neonates: A Systematic Review

Sokou,

Parastatidou,

Konstantinidi

et al. 2023

Semin Thromb Hemost

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We conducted a systematic review aiming to summarize the data on the current hemorrhage prediction models and evaluate their potential for generalized application in the neonatal population. The electronic databases PubMed and Scopus were searched, up to September 20, 2023, for studies that focused on development and/or validation of a prediction model for bleeding risk in neonates, and described the process of model building. Nineteen studies fulfilled the inclusion criteria for the present review. Eighteen bleeding risk prediction models in the neonatal population were identified, four of which were internally validated, one temporally and one externally validated. The existing prediction models for neonatal hemorrhage are mostly based on clinical variables and do not take into account the clinical course and hemostatic profile of the neonates. Most studies aimed at predicting the risk of intraventricular hemorrhage (IVH) reflecting the fact that IVH is the most frequent and serious bleeding complication in preterm neonates. A justification for the study sample size for developing the prediction model was given only by one study. Prediction and stratification of risk of hemorrhage in neonates is yet to be optimized. To this end, qualitative standards for model development need to be further improved. The assessment of the risk of bleeding incorporating platelet count, coagulation parameters, and a set of relevant clinical variables is crucial. Large, rigorous, collaborative cohort studies are warranted to develop a robust prediction model to inform the need for transfusion, which is a fundamental step towards personalized transfusion therapy in neonates.

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Contemporary tools for evaluation of hemostasis in neonates. Where are we and where are we headed?

Sokou,

Parastatidou,

Konstantinidi

et al. 2024

Blood Reviews

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Thromboelastometry and prediction of in‐hospital mortality in neonates with sepsis

Cited by 3 publications

References 31 publications

The frequency and timing of sepsis-associated coagulopathy in the neonatal intensive care unit

The frequency and timing of sepsis-associated coagulopathy in the neonatal intensive care unit

Bleeding Scoring Systems in Neonates: A Systematic Review

Contemporary tools for evaluation of hemostasis in neonates. Where are we and where are we headed?

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