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Published on: April 7, 2021
Risk factors for mortality in children with moderate-to-severe ARDS with concurrent hematological or immune-related
Qingyue Wang1,2, Hongxing Dang3, Yueqiang Fu1
1Pediatric Intensive Care Unit of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Insights
Children with moderate-to-severe acute respiratory distress syndrome (ARDS) and hematological/immune diseases face worse outcomes. Invasive fungal infections, vasoactive drug use, and high-frequency oscillatory ventilation increased mortality risk in this vulnerable pediatric group.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Hematology/Immunology
Background:
- Acute Respiratory Distress Syndrome (ARDS) is a complex condition, particularly severe in pediatric patients with comorbidities.
- Children with concurrent hematological or immune-related diseases present unique challenges in ARDS management.
- Investigating these specific patient groups is crucial for improving clinical outcomes.
Purpose of the Study:
- To characterize clinical features of pediatric patients with moderate-to-severe ARDS and concurrent hematological or immune diseases.
- To identify key risk factors associated with mortality in this specific pediatric ARDS population.
- To inform targeted treatment strategies and improve prognostication.
Main Methods:
- Retrospective observational study including 215 children with moderate-to-severe ARDS.
- Comparison between children with and without hematological/immune diseases.
- Logistic regression analysis to determine mortality risk factors.
Main Results:
- Children with hematological/immune diseases were older, had higher illness severity scores, and increased organ dysfunction.
- Higher rates of positive pathogen detection and shorter PICU stays were observed in this group.
- Invasive fungal infection, vasoactive drug use, and high-frequency oscillatory ventilation were significant mortality predictors.
Conclusions:
- Moderate-to-severe ARDS occurs more frequently and has a worse prognosis in children with hematological or immune-related diseases.
- Specific interventions like managing fungal infections and judicious use of vasoactive drugs and ventilation strategies are critical.
- Further research into this high-risk pediatric population is warranted.
Background:
As a heterogeneous syndrome, acute respiratory distress syndrome (ARDS) patients with comorbidities are significantly more severely ill. We aim to investigate the clinical characteristics and analyze the risk factors for mortality in children with moderate-to-severe acute respiratory distress syndrome (ARDS) who also have concurrent hematological or immune-related diseases.
Methods:
A retrospective observational study was conducted from September 2020 to May 2022 in the pediatric intensive care unit (PICU) at Children's Hospital of Chongqing Medical University (Chongqing, China). All children with moderate-to-severe ARDS were included and divided into two groups based on the presence or absence of hematological or immune-related diseases. Clinical characteristics, treatment, and outcome data were collected. Univariate logistic regression and multivariate Firth regression analysis were used to identify risk factors for mortality in children with moderate-to-severe ARDS with concurrent hematological or immune-related diseases.
Results:
A total of 215 children with moderate-to-severe ARDS were included in the study, of whom 65 had hematological or immune-related diseases (30.2%). These children were older (p < 0.001), had higher Pediatric Index of Mortality 3 scores (p = 0.002), higher lactate levels (p = 0.042), higher rates of positive pathogen detection (p < 0.001), shorter PICU stay (p = 0.023), higher incidence of multiple organ dysfunction syndrome (p = 0.012), and higher 28-day mortality rates (p < 0.001). Firth regression analysis showed that invasive fungal infection (OR = 4.954, 95% CI 0.245-3.158, p < 0.05), use of vasoactive drugs (OR = 7.638, 95% CI 0.524-3.811, p < 0.05), and high-frequency oscillatory ventilation (OR = 6.551, 95% CI 0.134-3.908, p < 0.05) were associated with increased mortality rates in children with moderate-to-severe ARDS with concurrent hematological or immune-related diseases.
Conclusion:
The incidence of moderate-to-severe ARDS is higher in children with concurrent hematological or immune-related diseases, and their prognosis is worse. In this group, children with invasive fungal infections, greater use of vasoactive drugs, or high-frequency oscillatory ventilation had a higher 28-day mortality rate.
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