344 - The assessment of sepsis-associated coagulopathy in septic neonates by using Thromboelastometry

Poster Number: 344
Publication Number: 344.122

Dimitra Gialamprinou, second department of neonatology and neonatal intensive care unit, faculty of medicine, aristotle university of Thessaloniki, "Papageorgiou" general hospital, Thessaloniki, Greece, Pylaia, Thessaloniki, Thessaloniki, Greece; Georgios Mitsiakos, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece, Thessaloniki, Thessaloniki, Greece; Abraham Pouliakis, National and Kapodistrian University of Athens, Athens, Attiki, Greece; Georgios N. Katsaras, Second Department of Neonatology and Neonatal Intensive Care Unit, Faculty of Medicine, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Thessaloniki, Greece, Thessaloniki, Thessaloniki, Greece; Christos-Georgios Kontovazainitis, 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece, Thessaloniki, Attiki, Greece; Ilias Chatziioannidis, PAPAGEORGIOU HOSPITAL, PEFKA, THESSALONIKI, Thessaloniki, Greece; Athanasios Moraitis, Papageorgiou General Hospital, Liti, Thessaloniki, Thessaloniki, Greece; Anastasia Banti, PAPAGEORGIOU HOSPITAL, THESSALONIKI, Thessaloniki, Greece; Alexandra Fleva, PAPAGEORGIOU GENERAL HOSPITAL, THESSALONIKI, Thessaloniki, Greece; Laura Bani Odeh, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Emmanuel Roilides, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Elisavet Diamanti, ARISTOTLE UNIVERSITY OF THESSALONIKI, Thessaloniki, Thessaloniki, Greece

Background: Rotational thromboelastometry (ROTEM) testing has been carried out in extend in adult sepsis to assess sepsis associated coagulopathy and partially in neonates.

Objective: The aim of this study was to assess coagulation during neonatal sepsis by using ROTEM.

Design/Methods: A prospective cohort study of neonates with sepsis was conducted from January 2020 to October 2021 by performing ROTEM. Matched healthy neonates served as control group. ROTEM variables were measured: clotting time (CT, sec); clot formation time (CFT, sec); the amplitude at 10, 20, and 30 min (A10, A20, A30); a angle (a); maximum clot firmness (MCF, mm); and lysis index at 45 and 60 min (LI45 and LI60, %).

Results: Twenty eight preterm hospitalized neonates (gestational age, median 31.4w, birth weight, median 1390gr) with sepsis compared with 30 matched healthy controls. Septic neonates: At first day of sepsis INTEM had prolonged CFT and reduced a (p 0.03, 0.03), in EXTEM no significant differences were observed and FIBTEM had higher A10, A20, A30, MCF, LI45, LI60 (p 0.02, 0.005, 0.001, 0.003, 0.01, 0.01). At 2nd-3rd day of sepsis INTEM had higher LI60 (p 0.04), in EXTEM assay no significant differences were observed and FIBTEM had higher A10, A20, A30, MCF, LI45, LI60 (p 0.002, 0.001, 0.0002, 0.0007, 0.03, 0.02). At 5th-7th day INTEM had higher A10, A20, A30, MCF, a and reduced CFT (p 0.008, 0.006, 0.003, 0.006, 0.01, 0.006), EXTEM had higher A10, A20, A30, MCF, a and reduced CFT (p 0.01, 0.02, 0.01, 0.02, 0.02, 0.04) and FIBTEM had reduced CT, higher A10, A20, A30, MCF, a (p 0.008, 0.001, 0.0002, 0.0003, 0.0001, 0.001). Septic neonates during sepsis: INTEM had increased A10, A20, A30, MCF, a and reduced CFT (p 0.0009, 0.0004, 0.0005, 0.001, 0.00001), EXTEM had reduced CT, CFT and increased A10, A20, A30, MCF, a (p 0.001, 0.001, 0.02, 0.03, 0.03, 0.04, 0.0006), FIBTEM had increased a (p 0.001).Conclusion(s): In septic neonates ROTEM parameters revealed hypercoagulable profile with hypofibrinolysis when compared with healthy controls. At first day of sepsis INTEM presents a likely hypocoagulable profile in the initiate stage of clot formation. During neonatal sepsis ROTEM parameters revealed an intense hypercoagulable process in all assays. Septic neonates are prone to a prothrombotic state due to consumption of coagulation inhibitors and coagulation activation along with inhibited fibrinolysis. ROTEM pattern in this study showed an evolved hypercoagulability, likely suggestive of the pathophysiology of coagulation-compensating mechanisms for restricting the spread of infection.
Table 1. Baseline characteristics of the study populationData are presented as frequencies with the corresponding percentages, or medians with interquartile ranges when appropriate.
Kruskal–Wallis rank test, chi-squared, and Fisher’s exact test were used for the statistical evaluations.
Table 2. Rotem parameters during sepsis by the patients’ groupData across the two study groups are presented as medians with interquartile ranges. The Wilcoxon rank-sum (Mann–Whitney) test for pairwise comparisons. CT clotting time (seconds), CFT clot formation time (seconds), A10 clot strength at 10 min (millimeters), A20 clot strength at 20 min (millimeter), A30 clot strength at 30 min (millimeters), Alpha a-angle (degrees), MCF maximal clot firmness (millimeters), LI45 lysis index at 45 min (percent), LI60 lysis index at 60 min (percent)