Endothelial Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Area of Science:

• Pediatric Critical Care Medicine
• Vascular Biology
• Biomarker Discovery

Background:

• Endothelial dysfunction is a critical factor in pediatric multiple organ dysfunction syndrome (pMODS).
• Accurate diagnosis of endothelial dysfunction in pMODS is challenging due to a lack of specific biomarkers.
• Understanding endothelial dysfunction is crucial for improving outcomes in critically ill children.

Purpose of the Study:

• To review and synthesize literature on endothelial dysfunction in critically ill children with pMODS.
• To develop a consensus definition and diagnostic criteria for endothelial dysfunction using biomarkers.
• To identify reliable biomarkers for diagnosing endothelial dysfunction in pMODS.

Main Methods:

• Comprehensive literature searches of PubMed and Embase (1992-2020).
• Inclusion of studies evaluating critically ill children, endothelial dysfunction, and relevant outcomes.
• Exclusion of adult studies, premature infants, animal studies, and non-English literature.

Main Results:

• Identified 62 studies with 84 assessments of endothelial-derived biomarkers.
• Biomarkers evaluated were indirectly linked to endothelial functions (e.g., inflammation, coagulation).
• Most biomarkers lacked specificity for vascular segments and organ systems; literature quality was low.

Conclusions:

• No single or combination of current biomarkers can diagnose endothelial dysfunction in pediatric multiple organ dysfunction syndrome.
• Future research must focus on biomarkers with direct links to endothelial functions and organ-specific relevance.
• Development of specific, reliable diagnostic criteria for endothelial dysfunction in pMODS is needed.