利用实际数据估算新生儿重症监护室凝血检测的妊娠年龄特异性参考区间。

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2024-12-01 DOI:10.1016/j.jtha.2024.08.017

Natasha Lalos , Zachary Vesoulis , Carly Maucione , Charles Eby , Dennis J. Dietzen , Stephen M. Roper , Nicholas C. Spies

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引用次数: 0

摘要

背景目前，对新生儿凝血检测结果的解释主要依赖于根据年龄较大的患者队列确定的参考区间（RI）。我们分析了 2018 年 1 月 1 日至 2024 年 1 月 1 日期间入住 IV 级新生儿重症监护病房的所有患者的首次生命凝血检测结果。不包括输注任何血液制品后获得的结果。结果1128名新生儿的凝血酶原时间（PT）和国际正常化比率（INR）可用，790名新生儿的活化部分凝血活酶时间（aPTT）可用。早产儿的 PT 间接 RI 为 10-25，足月儿为 10-22，所有新生儿为 10-24；早产儿的 INR 为 0.7-2.1，足月儿为 0.8-1.8，所有新生儿为 0.8-1.9；早产儿的 aPTT 为 25-68，足月儿为 25-58，所有新生儿为 25-62。结论重症监护室收治的新生儿中，间接估计的 RI 与当前的新生儿第一年 RI 有很大差异，导致了大量异常标记。这些标记与医疗服务提供者的行为、输血实践或临床结果之间的关联是未来需要探索的领域。

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Estimation of gestational age-specific reference intervals for coagulation assays in a neonatal intensive care unit using real-world data

Background

Interpretation of coagulation testing in neonates currently relies on reference intervals (RIs) defined from older patient cohorts. Direct RI studies are difficult, but indirect estimation may allow us to infer normative neonatal distributions from routinely collected clinical data.

Objective

Assess the utility of indirect reference interval methods in estimating coagulation reference intervals in critically ill neonates.

Methods

We analyzed first-in-life coagulation testing results from all patients admitted to a level IV neonatal intensive care unit between January 1, 2018, and January 1, 2024. Results obtained after transfusion of any blood product were excluded. Indirect RIs were estimated across gestational age groups using refineR and compared with currently reported intervals for patients less than 1 year of age.

Results

Prothrombin times (PTs) and international normalized ratios (INRs) were available for 1128 neonates, while activated partial thromboplastin times (APTTs) were available for 790 neonates. The indirect RI was 10 to 25 seconds in preterm, 10 to 22 seconds in term, and 10 to 24 seconds in all neonates for PT; 0.7 to 2.1 in preterm, 0.8 to 1.8 in term, and 0.8 to 1.9 in all neonates for INR; and 25 to 68 seconds in preterm, 25 to 58 seconds in term, and 25 to 62 seconds in all neonates for APTT. Compared with our current intervals, the indirect RIs would flag 58% fewer PT, 43% fewer INR, and 17% fewer APTT results as abnormal.

Conclusion

Indirectly estimated RIs in neonates admitted to intensive care show substantial divergence from current, first-year-of-life RIs, leading to an abundance of abnormal flags. The associations between these flags and provider behavior, transfusion practice, or clinical outcomes are areas of future exploration.

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.