Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry

Background: To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. Methods: The study population consisted of 473 consecutive term and preterm criti...

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Autores principales:	Rozeta Sokou, Maroula Tritzali, Daniele Piovani, Aikaterini Konstantinidi, Andreas G. Tsantes, Georgios Ioakeimidis, Maria Lampridou, Stavroula Parastatidou, Nicoletta Iacovidou, Styliani Kokoris, Georgios K. Nikolopoulos, Petros Kopterides, Stefanos Bonovas, Argirios E. Tsantes
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	thromboelastometry prognosis neonatal severity score coagulopathy Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/a03ee9f337024d5aaf55e63ad8e67e7e
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spelling	oai:doaj.org-article:a03ee9f337024d5aaf55e63ad8e67e7e2021-11-25T17:20:13ZComparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry10.3390/diagnostics111119552075-4418https://doaj.org/article/a03ee9f337024d5aaf55e63ad8e67e7e2021-10-01T00:00:00Zhttps://www.mdpi.com/2075-4418/11/11/1955https://doaj.org/toc/2075-4418Background: To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. Methods: The study population consisted of 473 consecutive term and preterm critically-ill neonates. On the first day of critical illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring system, Score for Neonatal Acute Physiology (SNAP II), Perinatal extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM standard extrinsically activated (EXTEM) assay was performed simultaneously. Time-to-event methodology for competing-risks was used to assess the performance of the aforementioned indexes in predicting in-hospital mortality over time. Time-dependent receiver operator characteristics curves for censored observation were compared across indexes. The addition of EXTEM parameters to each index was tested in terms of discrimination capacity. Results: The modified NEOMOD score performed similarly to SNAPPE. Both scores performed significantly better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10) was the EXTEM parameter most strongly associated with mortality (A10 < 37 mm vs. ≥37 mm; sHR = 5.52; <i>p</i> < 0.001). Adding A10 to each index apparently increased the prognostic accuracy in the case of SNAP II and SNAPPE II. However, these increases did not reach statistical significance. Conclusion: Although the four existing indexes considered showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE scores performed significantly better. Though larger studies are needed, adding A10 to well-established neonatal severity scores not including biomarkers of coagulopathy might improve their prediction of in-hospital mortality.Rozeta SokouMaroula TritzaliDaniele PiovaniAikaterini KonstantinidiAndreas G. TsantesGeorgios IoakeimidisMaria LampridouStavroula ParastatidouNicoletta IacovidouStyliani KokorisGeorgios K. NikolopoulosPetros KopteridesStefanos BonovasArgirios E. TsantesMDPI AGarticlethromboelastometryprognosisneonatal severity scorecoagulopathyMedicine (General)R5-920ENDiagnostics, Vol 11, Iss 1955, p 1955 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	thromboelastometry prognosis neonatal severity score coagulopathy Medicine (General) R5-920
spellingShingle	thromboelastometry prognosis neonatal severity score coagulopathy Medicine (General) R5-920 Rozeta Sokou Maroula Tritzali Daniele Piovani Aikaterini Konstantinidi Andreas G. Tsantes Georgios Ioakeimidis Maria Lampridou Stavroula Parastatidou Nicoletta Iacovidou Styliani Kokoris Georgios K. Nikolopoulos Petros Kopterides Stefanos Bonovas Argirios E. Tsantes Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
description	Background: To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. Methods: The study population consisted of 473 consecutive term and preterm critically-ill neonates. On the first day of critical illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring system, Score for Neonatal Acute Physiology (SNAP II), Perinatal extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM standard extrinsically activated (EXTEM) assay was performed simultaneously. Time-to-event methodology for competing-risks was used to assess the performance of the aforementioned indexes in predicting in-hospital mortality over time. Time-dependent receiver operator characteristics curves for censored observation were compared across indexes. The addition of EXTEM parameters to each index was tested in terms of discrimination capacity. Results: The modified NEOMOD score performed similarly to SNAPPE. Both scores performed significantly better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10) was the EXTEM parameter most strongly associated with mortality (A10 < 37 mm vs. ≥37 mm; sHR = 5.52; <i>p</i> < 0.001). Adding A10 to each index apparently increased the prognostic accuracy in the case of SNAP II and SNAPPE II. However, these increases did not reach statistical significance. Conclusion: Although the four existing indexes considered showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE scores performed significantly better. Though larger studies are needed, adding A10 to well-established neonatal severity scores not including biomarkers of coagulopathy might improve their prediction of in-hospital mortality.
format	article
author	Rozeta Sokou Maroula Tritzali Daniele Piovani Aikaterini Konstantinidi Andreas G. Tsantes Georgios Ioakeimidis Maria Lampridou Stavroula Parastatidou Nicoletta Iacovidou Styliani Kokoris Georgios K. Nikolopoulos Petros Kopterides Stefanos Bonovas Argirios E. Tsantes
author_facet	Rozeta Sokou Maroula Tritzali Daniele Piovani Aikaterini Konstantinidi Andreas G. Tsantes Georgios Ioakeimidis Maria Lampridou Stavroula Parastatidou Nicoletta Iacovidou Styliani Kokoris Georgios K. Nikolopoulos Petros Kopterides Stefanos Bonovas Argirios E. Tsantes
author_sort	Rozeta Sokou
title	Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
title_short	Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
title_full	Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
title_fullStr	Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
title_full_unstemmed	Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
title_sort	comparative performance of four established neonatal disease scoring systems in predicting in-hospital mortality and the potential role of thromboelastometry
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/a03ee9f337024d5aaf55e63ad8e67e7e
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Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry

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