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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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Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Thivon 1, Goudi, 11527 Athens, Greece
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Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
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IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
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Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece
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Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 15772 Athens, Greece
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Medical School, University of Cyprus, Nicosia 1678, Cyprus
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Intensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, PA 15601, USA
*
Author to whom correspondence should be addressed.
Contributed equally as co-first authors.
Academic Editor: Antonio Maccio
Diagnostics 2021, 11(11), 1955; https://doi.org/10.3390/diagnostics11111955
Received: 10 September 2021 / Revised: 14 October 2021 / Accepted: 18 October 2021 / Published: 21 October 2021
(This article belongs to the Section Pathology and Molecular Diagnostics)
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; p < 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. View Full-Text
Keywords: thromboelastometry; prognosis; neonatal severity score; coagulopathy thromboelastometry; prognosis; neonatal severity score; coagulopathy
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MDPI and ACS Style

Sokou, R.; Tritzali, M.; Piovani, D.; Konstantinidi, A.; Tsantes, A.G.; Ioakeimidis, G.; Lampridou, M.; Parastatidou, S.; Iacovidou, N.; Kokoris, S.; Nikolopoulos, G.K.; Kopterides, P.; Bonovas, S.; Tsantes, A.E. Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry. Diagnostics 2021, 11, 1955. https://doi.org/10.3390/diagnostics11111955

AMA Style

Sokou R, Tritzali M, Piovani D, Konstantinidi A, Tsantes AG, Ioakeimidis G, Lampridou M, Parastatidou S, Iacovidou N, Kokoris S, Nikolopoulos GK, Kopterides P, Bonovas S, Tsantes AE. Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry. Diagnostics. 2021; 11(11):1955. https://doi.org/10.3390/diagnostics11111955

Chicago/Turabian Style

Sokou, Rozeta, 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, and Argirios E. Tsantes 2021. "Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry" Diagnostics 11, no. 11: 1955. https://doi.org/10.3390/diagnostics11111955

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