Analysis of risk factors of mortality in infants and toddlers with moderate to severe pediatric acute respiratory distress syndrome.
10.3760/cma.j.cn112140-20221108-00947
- Author:
Bo Liang FANG
1
;
Feng XU
2
;
Guo Ping LU
3
;
Xiao Xu REN
4
;
Yu Cai ZHANG
5
;
You Peng JIN
6
;
Ying WANG
7
;
Chun Feng LIU
8
;
Yi Bing CHENG
9
;
Qiao Zhi YANG
10
;
Shu Fang XIAO
11
;
Yi Yu YANG
12
;
Xi Min HUO
13
;
Zhi Xian LEI
14
;
Hong Xing DANG
2
;
Shuang LIU
4
;
Zhi Yuan WU
12
;
Ke Chun LI
1
;
Su Yun QIAN
1
;
Jian Sheng ZENG
1
Author Information
1. Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China.
2. Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing 400014,China.
3. Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai 201102,China.
4. Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020,China.
5. Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200062,China.
6. Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021,China.
7. Department of Pediatric Critical Care Medicine Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127,China.
8. Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004,China.
9. Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450000,China.
10. Department of Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng 252000,China.
11. Department of Pediatric Intensive Care Unit, Kunming Children's Hospital, Kunming 650034,China.
12. Department of Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou 510623,China.
13. Department of Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang 050031,China.
14. Department of Pediatric Intensive Care Unit, Hainan Women and Children's Medical Center, Haikou 570206, China.
- Publication Type:Journal Article
- MeSH:
Female;
Male;
Humans;
Child, Preschool;
Infant;
Child;
Critical Illness;
Pulmonary Surfactants/therapeutic use*;
Retrospective Studies;
Risk Factors;
Respiratory Distress Syndrome/therapy*
- From:
Chinese Journal of Pediatrics
2023;61(3):216-221
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To identify the risk factors in mortality of pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU). Methods: Second analysis of the data collected in the "efficacy of pulmonary surfactant (PS) in the treatment of children with moderate to severe PARDS" program. Retrospective case summary of the risk factors of mortality of children with moderate to severe PARDS who admitted in 14 participating tertiary PICU between December 2016 to December 2021. Differences in general condition, underlying diseases, oxygenation index, and mechanical ventilation were compared after the group was divided by survival at PICU discharge. When comparing between groups, the Mann-Whitney U test was used for measurement data, and the chi-square test was used for counting data. Receiver Operating Characteristic (ROC) curves were used to assess the accuracy of oxygen index (OI) in predicting mortality. Multivariate Logistic regression analysis was used to identify the risk factors for mortality. Results: Among 101 children with moderate to severe PARDS, 63 (62.4%) were males, 38 (37.6%) were females, aged (12±8) months. There were 23 cases in the non-survival group and 78 cases in the survival group. The combined rates of underlying diseases (52.2% (12/23) vs. 29.5% (23/78), χ2=4.04, P=0.045) and immune deficiency (30.4% (7/23) vs. 11.5% (9/78), χ2=4.76, P=0.029) in non-survival patients were significantly higher than those in survival patients, while the use of pulmonary surfactant (PS) was significantly lower (8.7% (2/23) vs. 41.0% (32/78), χ2=8.31, P=0.004). No significant differences existed in age, sex, pediatric critical illness score, etiology of PARDS, mechanical ventilation mode and fluid balance within 72 h (all P>0.05). OI on the first day (11.9(8.3, 17.1) vs.15.5(11.7, 23.0)), the second day (10.1(7.6, 16.6) vs.14.8(9.3, 26.2)) and the third day (9.2(6.6, 16.6) vs. 16.7(11.2, 31.4)) after PARDS identified were all higher in non-survival group compared to survival group (Z=-2.70, -2.52, -3.79 respectively, all P<0.05), and the improvement of OI in non-survival group was worse (0.03(-0.32, 0.31) vs. 0.32(-0.02, 0.56), Z=-2.49, P=0.013). ROC curve analysis showed that the OI on the thind day was more appropriate in predicting in-hospital mortality (area under the curve= 0.76, standard error 0.05,95%CI 0.65-0.87,P<0.001). When OI was set at 11.1, the sensitivity was 78.3% (95%CI 58.1%-90.3%), and the specificity was 60.3% (95%CI 49.2%-70.4%). Multivariate Logistic regression analysis showed that after adjusting for age, sex, pediatric critical illness score and fluid load within 72 h, no use of PS (OR=11.26, 95%CI 2.19-57.95, P=0.004), OI value on the third day (OR=7.93, 95%CI 1.51-41.69, P=0.014), and companied with immunodeficiency (OR=4.72, 95%CI 1.17-19.02, P=0.029) were independent risk factors for mortality in children with PARDS. Conclusions: The mortality of patients with moderate to severe PARDS is high, and immunodeficiency, no use of PS and OI on the third day after PARDS identified are the independent risk factors related to mortality. The OI on the third day after PARDS identified could be used to predict mortality.
