Sokou Rozeta, Tritzali Maroula, Piovani Daniele, Konstantinidi Aikaterini, Tsantes Andreas G, Ioakeimidis Georgios, Lampridou Maria, Parastatidou Stavroula, Iacovidou Nicoletta, Kokoris Styliani, Nikolopoulos Georgios K, Kopterides Petros, Bonovas Stefanos, Tsantes Argirios E
Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece.
First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon 1, Goudi, 11527 Athens, Greece.
Diagnostics (Basel). 2021 Oct 21;11(11):1955. doi: 10.3390/diagnostics11111955.
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.
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.
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; < 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.
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.
比较最常用的死亡率指标随时间变化的预后准确性，并评估将血栓弹力图（ROTEM）结果添加到这些成熟的临床评分中的潜力。
研究人群包括473例连续的足月和早产危重新生儿。在危重病的第一天，计算改良新生儿多器官功能障碍（NEOMOD）评分系统、新生儿急性生理学评分（SNAP II）、SNAP围产期扩展评分（SNAPPE）和SNAPPE II，并同时进行ROTEM标准外源性激活（EXTEM）检测。采用竞争风险的事件发生时间方法来评估上述指标在预测随时间变化的院内死亡率方面的表现。比较各指标的删失观察的时间依赖性受试者工作特征曲线。就区分能力测试了将EXTEM参数添加到每个指标中的情况。
改良NEOMOD评分与SNAPPE表现相似。这两个评分均显著优于SNAP II和SNAPPE II。10分钟时记录的振幅（A10）是与死亡率最密切相关的EXTEM参数（A10 < 37 mm与≥37 mm相比；sHR = 5.52；P < 0.001）。在SNAP II和SNAPPE II的情况下，将A10添加到每个指标中显然提高了预后准确性。然而，这些提高未达到统计学显著性。
尽管所考虑的四个现有指标显示出良好至优异的预后能力，但改良NEOMOD和SNAPPE评分表现明显更好。尽管需要更大规模的研究，但将A10添加到不包括凝血病生物标志物的成熟新生儿严重程度评分中可能会改善对院内死亡率的预测。
