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

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.