605: CORRELATION BETWEEN PLASMA-BASED AND VISCOELASTIC COAGULATION ASSAYS IN PEDIATRIC LIVER FAILURE

Abstract

Introduction: Liver failure (LF) causes complex coagulation abnormalities leading to bleeding and clotting events. Routinely used plasma-based coagulation (PBC) assays, including international normalized ratio (INR), activated partial thromboplastin time (aPTT), and fibrinogen, have limited bleeding or clotting risk prediction. Whole blood-based viscoelastic assays, including rotational thromboelastometry (ROTEM) and thromboelastography (TEG), are increasingly used to characterize coagulation abnormalities to predict bleeding or clotting events in adults with LF. In this novel study, we aimed to compare PBC assays with ROTEM in pediatric LF as no published data are available yet. Methods: We analyzed a retrospective cohort of children with LF listed for transplant at a tertiary hospital. Samples with simultaneous measurements of PBC assays and ROTEM assays were analyzed. A stratified analysis compared critically ill children admitted to PICU and non-critically ill children from home or acute care before surgery. Results: 63 patients with median age of 38 [IQR 8-149] months, 57% female, 33% in the PICU had 110 simultaneous ROTEM and PBC assays analyzed. About 65% of INR values and 76% of platelet counts were outside the normal range compared to 32% of EXTEM clotting time (CT) (p< 0.001) and 43% of EXTEM maximum clot firmness (MCF) (p< 0.001) respectively. INR showed a weak correlation with EXTEM CT (Spearman’s Coefficient (r)=0.55, p< 0.001) in the entire cohort with no difference between critically ill and not critically ill children. aPTT demonstrated a moderate correlation with INTEM CT (r=0.67, p< 0.001). This correlation was stronger in critically ill children (r=0.78, p< 0.001) compared to the non-critically ill children (r=0.46, p< 0.001). Fibrinogen and platelet count had a strong correlation with FIBTEM and EXTEM MCF (r=0.82 and r=0.80, respectively, p< 0.001) that was similar in the two groups. Conclusions: Children with LF have less frequent coagulation abnormalities on ROTEM compared to PBC assays. INR, traditionally used for prognostication and decision-making, has a weak correlation with EXTEM values on ROTEM regardless of disease severity in children with LF. Determining the association between INR and ROTEM with bleeding or clotting events is needed to ascertain their clinical application.