Department of Pediatrics, Division of Pediatric Critical Care
Clinical Epidemiology | Critical Care | Disease Modeling | Epidemiology | Pediatrics | Respiratory Tract Diseases
OBJECTIVES: Pediatric acute respiratory distress syndrome is heterogeneous, with a paucity of risk stratification tools to assist with trial design. We aimed to develop and validate mortality prediction models for patients with pediatric acute respiratory distress syndrome.
DESIGN: Leveraging additional data collection from a preplanned ancillary study (Version 1) of the multinational Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology study, we identified predictors of mortality. Separate models were built for the entire Version 1 cohort, for the cohort excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths. Models were externally validated in a cohort of intubated pediatric acute respiratory distress syndrome patients from the Children's Hospital of Philadelphia.
SETTING: The derivation cohort represented 100 centers worldwide; the validation cohort was from Children's Hospital of Philadelphia.
PATIENTS: There were 624 and 640 subjects in the derivation and validation cohorts, respectively.
MEASUREMENTS AND MAIN RESULTS: The model for the full cohort included immunocompromised status, Pediatric Logistic Organ Dysfunction 2 score, day 0 vasopressor-inotrope score and fluid balance, and PaO2/FIO2 6 hours after pediatric acute respiratory distress syndrome onset. This model had good discrimination (area under the receiver operating characteristic curve 0.82), calibration, and internal validation. Models excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths also demonstrated good discrimination (all area under the receiver operating characteristic curve > /= 0.84) and calibration. In the validation cohort, models for intubated pediatric acute respiratory distress syndrome (including and excluding neurologic deaths) had excellent discrimination (both area under the receiver operating characteristic curve > /= 0.85), but poor calibration. After revision, the model for all intubated subjects remained miscalibrated, whereas the model excluding neurologic deaths showed perfect calibration. Mortality models also stratified ventilator-free days at 28 days in both derivation and validation cohorts.
CONCLUSIONS: We describe predictive models for mortality in pediatric acute respiratory distress syndrome using readily available variables from day 0 of pediatric acute respiratory distress syndrome which outperform severity of illness scores and which demonstrate utility for composite outcomes such as ventilator-free days. Models can assist with risk stratification for clinical trials.
mortality, pediatric acute respiratory distress syndrome, prediction, risk stratification, ventilator-free days
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Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
DOI of Published Version
Yehya N, Harhay MO, Klein MJ, Shein SL, Piñeres-Olave BE, Izquierdo L, Sapru A, Emeriaud G, Spinella PC, Flori HR, Dahmer MK, Maddux AB, Lopez-Fernandez YM, Haileselassie B, Hsing DD, Chima RS, Hassinger AB, Valentine SL, Rowan CM, Kneyber MCJ, Smith LS, Khemani RG, Thomas NJ; Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V1 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study. Crit Care Med. 2020 Jun;48(6):e514-e522. doi: 10.1097/CCM.0000000000004345. PMID: 32271186; PMCID: PMC7237024. Link to article on publisher's site
Critical care medicine
Yehya N, Valentine SL. (2020). Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study. Pediatric Publications. https://doi.org/10.1097/CCM.0000000000004345. Retrieved from https://escholarship.umassmed.edu/peds_pp/302
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.