A Risk Score for Predicting the Incidence of Hemorrhage in Critically Ill Neonates: Development and Validation Study (original) (raw)
Thromb Haemost 2021; 121(02): 131-139
DOI: 10.1055/s-0040-1715832
Coagulation and Fibrinolysis
Authors
- Rozeta Sokou
1Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece - Daniele Piovani
2Department of Biomedical Sciences, Humanitas University, Milan, Italy
3Humanitas Clinical and Research Center, IRCCS, Milan, Italy - Aikaterini Konstantinidi
1Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece - Andreas G. Tsantes
4Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece - Stavroula Parastatidou
1Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece - Maria Lampridou
1Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece - Georgios Ioakeimidis
1Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece - Antonis Gounaris
5Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece - Nicoletta Iacovidou
6Neonatal Department, Aretaeio Hospital, National and Kapodistrian University of Athens, Athens, Greece - Anastasios G. Kriebardis
7Department of Biomedical Science, Laboratory of Reliability and Quality Control in Laboratory Hematology, School of Health and Caring Science, University of West Attica, Egaleo, Greece - Marianna Politou
8Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece - Petros Kopterides
9Intensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, Pennsylvania, United States - Stefanos Bonovas
2Department of Biomedical Sciences, Humanitas University, Milan, Italy
3Humanitas Clinical and Research Center, IRCCS, Milan, Italy - Argirios E. Tsantes
4Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Funding None declared.
Further Information(opens Publication History section)
Abstract
The aim of the study was to develop and validate a prediction model for hemorrhage in critically ill neonates which combines rotational thromboelastometry (ROTEM) parameters and clinical variables. This cohort study included 332 consecutive full-term and preterm critically ill neonates. We performed ROTEM and used the neonatal bleeding assessment tool (NeoBAT) to record bleeding events. We fitted double selection least absolute shrinkage and selection operator logit regression to build our prediction model. Bleeding within 24 hours of the ROTEM testing was the outcome variable, while patient characteristics, biochemical, hematological, and thromboelastometry parameters were the candidate predictors of bleeding. We used both cross-validation and bootstrap as internal validation techniques. Then, we built a prognostic index of bleeding by converting the coefficients from the final multivariable model of relevant prognostic variables into a risk score. A receiver operating characteristic analysis was used to calculate the area under curve (AUC) of our prediction index. EXTEM A10 and LI60, platelet counts, and creatinine levels were identified as the most robust predictors of bleeding and included them into a Neonatal Bleeding Risk (NeoBRis) index. The NeoBRis index demonstrated excellent model performance with an AUC of 0.908 (95% confidence interval [CI]: 0.870–0.946). Calibration plot displayed optimal calibration and discrimination of the index, while bootstrap resampling ensured internal validity by showing an AUC of 0.907 (95% CI: 0.868–0.947). We developed and internally validated an easy-to-apply prediction model of hemorrhage in critically ill neonates. After external validation, this model will enable clinicians to quantify the 24-hour bleeding risk.
Keywords
thromboelastometry - prediction model - hemorrhage - critically ill neonates - Neonatal Bleeding Risk index
Publication History
Received: 19 April 2020
Accepted: 21 July 2020
Article published online:
24 August 2020
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