A clotting time longer than 226 s in the INTEM channel of the thromboelastometer is an independent risk factor for mortality during bleeding

Abstract

Background and objective: During bleeding the prolongation of the clotting time (CTINTEM) measured by rotational thromboelastometry (ROTEM) can detect alterations in the intrinsic pathway; however, the significance of a prolonged CTINTEM for risk stratification in patients with bleeding and the treatment with fresh frozen plasma remains unclear. Material and methods: A total of 2197 consecutive patients between 2014 and 2020 were retrospectively investigated. All patients were tested by ROTEM during bleeding at the Saarland University Hospital. The CTINTEM values were compared to mortality at 30 days. Discrimination was assessed with C statistic. Adjusted hazard ratios (adjHR, 95% confidence interval, CI) were calculated with multivariable Cox models. Results: The results of the C‑statistic showed that CTINTEM (C statistic 0.62, optimal threshold > 226 s) had a predictive power for 30-day mortality. The determined threshold value of CTINTEM > 226 s remained an independent risk predictor for 30-day mortality even after adjustment for confounding factors (adjHR 2.6, 95% CI 2.1–3.2, p < 0.001). The 30-day mortality rate was significantly increased in the group with CTINTEM > 226 s (29% versus 15%, p < 0.001). A multivariable analysis showed that treatment with fresh frozen plasma was not associated with increased 30-day mortality in patients with CTINTEM > 226 s, in contrast to all patients. Conclusion: Our results indicate that CTINTEM > 226s detected alterations in the intrinsic pathway might be an independent predictor for 30-day mortality in patients with bleeding and could be useful for decision making regarding treatment with fresh frozen plasma.