Association of fibrinogen and Rotational Thromboelastometry (ROTEM) parameters with age and race in a diverse pediatric population: a single-center study.

Abstract

Background: Rotational thromboelastometry (ROTEM) is a whole-blood viscoelastic analyzer providing a global assessment of coagulation. Reference intervals (RIs) for ROTEM are limited in pediatrics, often not accounting for race. Moreover, discrete RIs may be misleading.

Objectives: Our objective was to investigate the relationship between age (as a continuous variable) and race in ROTEM and conventional coagulation tests.

Methods: Prospective data from 105 racially diverse pediatric subjects (aged 1-21 years) were collected. ROTEM and conventional coagulation tests (prothrombin time, activated partial thromboplastin time, and fibrinogen) were obtained. The cohort was analyzed as a whole and then stratified by race.

Results: There was a positive association of age with fibrinogen levels (R² = .189; P < .0001), FIBTEM amplitude at 10 minutes after clotting time (A10; R² = .154; P = .0001), and FIBTEM maximum clot firmness (MCF; R² = .157; P = .0001) in the entire cohort. For race stratification, only Black/African American subjects showed a negative association of age with EXTEM clot formation time, but a positive association with EXTEM/INTEM A10 and MCF (P < .001), as well as FIBTEM A10 and MCF (P < .001), revealing a propensity for a prothrombotic state in Black/African American subjects.

Conclusion: This study reports race-specific age-related differences in fibrinogen and ROTEM, and describes ROTEM parameters as continuous variables by age. Inclusion of a diverse population in establishing race-specific pediatric RIs has clinical and public health relevance for a more accurate diagnosis and personalized treatment.