Prospective Temporal Validation of the Neonatal Bleeding Risk (NeoBRis) Index

Sokou, Rozeta; Piovani, Daniele; Konstantinidi, Aikaterini; Tsantes, Andreas G.; Parastatidou, Stavroula; Lampridou, Maria; Ioakeimidis, Georgios; Iacovidou, Nicoletta; Bonovas, Stefanos; Tsantes, Argirios Ε.

doi:10.1055/a-1343-3342

Cited by 10 publications

(14 citation statements)

References 18 publications

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“…Furthermore, EXTEM A10 has been independently and significantly associated with increased risk of mortality in critically ill neonates (50), while incorporating this variable in selected well-established neonatal disease severity scoring systems may improve their predictive performance for mortality (51). Finally, EXTEM A10 is included as a variable in the NeoBRis score for prediction of 24-hour bleeding risk in critically ill neonates (23,52). Sepsis complications could be devastating and lifethreatening in neonates.…”

Section: Discussionmentioning

confidence: 99%

“…Most parameters were very highly correlated (r S > 0.80 and p < 0.05). To avoid substantial multicollinearity in our model development, the ROTEM parameter most associated with sepsis in a univariable logistic regression (i.e., highest likelihood ratio chi-squared test), i.e., A10 was retained as the candidate predictor (23). A complete list of all candidate predictors is available in our extended method section (Supplementary data).…”

Section: Statistical Analysis and Model Developmentmentioning

confidence: 99%

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Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis

et al. 2022

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BackgroundWe aimed to develop and validate a diagnostic model for sepsis among neonates evaluated for suspected sepsis, by incorporating thromboelastometry parameters, maternal/neonatal risk factors, clinical signs/symptoms and laboratory results.MethodsThis retrospective cohort study included 291 neonates with presumed sepsis, hospitalized in a NICU, from 07/2014 to 07/2021. Laboratory tests were obtained on disease onset and prior to initiating antibiotic therapy. Τhromboelastometry extrinsically activated (EXTEM) assay was performed simultaneously and Tοllner and nSOFA scores were calculated. Sepsis diagnosis was the outcome variable. A 10-fold cross-validation least absolute shrinkage and selection operator logit regression procedure was applied to derive the final multivariable score. Clinical utility was evaluated by decision curve analysis.ResultsGestational age, CRP, considerable skin discoloration, liver enlargement, neutrophil left shift, and EXTEM A10, were identified as the strongest predictors and included in the Neonatal Sepsis Diagnostic (NeoSeD) model. NeoSeD score demonstrated excellent discrimination capacity for sepsis and septic shock with an AUC: 0.918 (95% CI, 0.884–0.952) and 0.974 (95% CI, 0.958–0.989) respectively, which was significantly higher compared to Töllner and nSOFA scores.ConclusionsThe NeoSeD score is simple, accurate, practical, and may contribute to a timely diagnosis of sepsis in neonates with suspected sepsis. External validation in multinational cohorts is necessary before clinical application.

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Section: Discussionmentioning

confidence: 99%

Section: Statistical Analysis and Model Developmentmentioning

confidence: 99%

Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis

et al. 2022

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“…31 32 Likewise, fibrinolysis shutdown, demonstrated through an EXTEM LI60 increase, has shown good predictive value for bleeding risk in ill neonates. 26 28 29…”

Section: Discussionmentioning

confidence: 99%

The Utility of NATEM Assay in Predicting Bleeding Risk in Critically Ill Neonates

Sokou

Georgiadou

Tsantes

et al. 2022

Semin Thromb Hemost

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We aimed to investigate the hemostatic status of diseased neonates using nonactivated rotational thromboelastometry (ROTEM) assay (NATEM) assay and, in addition, to evaluate the discriminative power of NATEM parameters in predicting the risk of bleeding in critically ill neonates and compare it to that of EXTEM (extrinsically activated ROTEM) parameters. This cohort study included 158 consecutive, critically ill neonates with presumed sepsis, perinatal hypoxia, or respiratory distress syndrome. The EXTEM and NATEM assays were performed on the first day of disease onset. The neonatal bleeding assessment tool was used to record and assess clinical bleeding events on the day of ROTEM analysis. Several EXTEM and NATEM ROTEM parameters differed between neonates with and without clinical bleeding events, indicating a hypo-coagulable state in neonates with clinical bleeding. NATEM parameters had comparable predictive performance for clinical bleeding events with EXTEM parameters for clotting time, clot formation time (CFT), A10 (clot amplitude at 10minutes), maximum clot firmness, lysis index at 60minutes, and maximum clot elasticity (p>0.05). However, NATEM A20, A30, and α angle demonstrated better predictive ability than EXTEM A20, A30, and α angle, respectively (p<0.05). A NATEM CFT value ≥147seconds presented 95.2% sensitivity (95% confidence interval [CI]: 76.1–99.8%) and 65.6% specificity (95% CI: 57.1–73.5%) to detect neonates with clinical bleeding, while a NATEM A10 value ≤42mm had 80.8% sensitivity (95% CI: 71.8–85.9%) and 76.0% specificity (95% CI: 52.8–91.7%) to detect neonates with clinical bleeding events. The NATEM assay has shown remarkable sensitivity in predicting bleeding in critically ill neonates, exceeding EXTEM performance in some selected parameters. The incorporation of NATEM test parameters in predictive models for neonatal hemorrhage seems promising.

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“…This assay allows the dynamic visualization of the viscoelastic properties of Diagnostics 2022, 12, 658 2 of 15 blood through a graphical representation of thrombin formation, fibrin polymerization and clot lysis, while it takes into account the complex interactions among different cellular populations, providing a point of care and a detailed evaluation of the patient's hemostatic profile [4]. Existing evidence supports the utility of ROTEM assays in the diagnosis of bleeding conditions and in the prediction of mortality in critically ill patients as well as in predicting and guiding transfusion therapy [4][5][6][7][8]; the non-activated thromboelastometry (NATEM) assay is a particular test of ROTEM and evaluates both the intrinsic and the extrinsic coagulation pathways without the addition of any reagents for activation of coagulation. Hence, compared to the EXTEM and INTEM assays where tissue factor and ellagic acid are used, respectively; in order to activate coagulation, a NATEM assay may more accurately depict the hemostatic mechanism in vivo [4].…”

Section: Introductionmentioning

confidence: 99%

The Non-Activated Thromboelastometry (NATEM) Assay’s Application among Adults and Neonatal/Pediatric Population: A Systematic Review

et al. 2022

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The non-activated thromboelastometry (NATEM) assay is a point-of-care assay that can provide a comprehensive insight into the actual hemostatic mechanism. However, there are very limited data about its use in clinical practice. The aim of this study was to systematically review the literature for any data regarding the use of NATEM in several clinical settings. A systematic review of PubMed and Scopus databases was conducted through 20 January 2022 for studies evaluating the use of the NATEM assay in different clinical settings. The literature search yielded a total of 47 publications, 30 of which met the eligibility criteria for this review. Evaluation of NATEM’s detecting ability for hemostasis disorders is limited in the literature. The results of the included studies indicate that NATEM seems to be a sensitive method for the detection of hyperfibrinolysis and may have an advantage in the diagnosis of hemostatic disorders. It could be more informative than the other ROTEM assays for detecting changes in coagulation parameters in patients who receive anticoagulants. However, the reported outcomes are highly varying among the included studies. NATEM has a high sensitivity to detect hypo- or hypercoagulability and provides a detailed insight into the whole hemostatic process from clot formation to clot breakdown. It could be a useful technique in variable fields of medicine, not only in adults, but also in pediatric and neonatal populations, to guide different hemostatic treatments and predict coagulation disorders or mortality/morbidity; this issue remains to be further investigated.

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Prospective Temporal Validation of the Neonatal Bleeding Risk (NeoBRis) Index

Abstract: No Abstract

Cited by 10 publications

References 18 publications

Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis

Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis

The Utility of NATEM Assay in Predicting Bleeding Risk in Critically Ill Neonates

The Non-Activated Thromboelastometry (NATEM) Assay’s Application among Adults and Neonatal/Pediatric Population: A Systematic Review

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