Introduction
ROTEM sigma (Rotation Thromboelastometry) is a device used for detection of coagulation disorders in case of important hemorrhage. Our aim is to compare ROTEM results with standard laboratory tests in order to evaluate their correlation and define cut-off values for the management of bleeding.
Methods
ROTEM results from 783 patients were compared to standard laboratory test carried out from the same blood sample of patients suffering major or massive bleeding in a single tertiary university hospital. Participants were divided into different target population groups for the analysis.
Results
For the Overall group (all patients included in the study), EXTEM CT > 66 seconds has the best Youden index and a 56% sensitivity and a 75% specificity to predict an INR > 1.2. CT INTEM > 207 seconds has a 78% sensitivity and a 90% specificity for an aPTT ratio > 1.5. FIBTEM A5 ≤ 14 mm showed a sensitivity of 100 and a specificity of 50% in identification of fibrinogen levels below 1.5 g/L. EXTEM A5 ≤ 39 mm identified a fibrinogen level < 1.5 g/L with 93.1% sensitivity and 69% specificity. PLTEM A5 ≤ 21 mm identified platelet count level < 50 G/L with a 100% sensitivity and a 84% specificity, while EXTEM A5 ≤ 34 mm identified the same platelet count level with a 90% sensitivity and a 78% specificity. To identify platelet count levels below 100 G/L, PLTEM A5 ≤ 23 mm had a 76% sensitivity and a 88% specificity, while EXTEM A5 ≤ 38 mm had a 77% sensitivity and a 73% specificity. Subgroups analysis for Cardiac surgery, Trauma and Non cardiac surgery are presented in the manuscript.
Conclusion
The authors propose 3 different sigma-based ROTEM algorithms specific to the 3 groups analyzed for hemorrhage management. Our study allows the development of algorithms specific to subgroups of patients having coagulopathies with different pathophysiological bases.