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Published on: April 7, 2021
Development and Validation of a Prediction Model for Early ARDS in Children with Sepsis in the PICU: A Multicenter
Dilare Aihaiti1, Abulaiti Abuduhaer1
1Department of Pediatric Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, People's Republic of China.
Insights
Early identification of pediatric acute respiratory distress syndrome (PARDS) in sepsis is crucial. Lower hemoglobin, higher LAR, septic shock, and a higher Phoenix Sepsis Score are key risk factors for PARDS development.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Infectious diseases
Background:
- Pediatric acute respiratory distress syndrome (PARDS) is a severe complication in children with sepsis.
- Early identification of risk factors is essential for timely intervention and improved outcomes.
- Current prediction models for PARDS in sepsis require further development and validation.
Purpose of the Study:
- To identify early clinical factors associated with PARDS within 48 hours of sepsis diagnosis in children.
- To develop and validate a predictive model for early PARDS detection in pediatric sepsis.
- To improve risk stratification and guide early management strategies for children with sepsis.
Main Methods:
- Retrospective cohort study of 547 children with sepsis in a pediatric intensive care unit.
- Sepsis and PARDS diagnosed using Phoenix and PALICC-2 criteria.
- Multivariable logistic regression analysis of clinical data within 2 hours of admission to construct a prediction model.
- External validation of the model using an independent cohort of 100 children.
Main Results:
- 26.7% of children with sepsis developed PARDS within 48 hours.
- Independent risk factors for early PARDS included lower hemoglobin, higher LAR, septic shock, and higher Phoenix Sepsis Score.
- The developed model demonstrated high predictive performance with an AUC of 0.911 in the derivation cohort and 0.873 in the external cohort.
Conclusions:
- Elevated LAR, higher Phoenix Sepsis Score, septic shock, and lower hemoglobin levels are significant risk factors for PARDS in pediatric sepsis.
- The developed prediction model shows promise for early identification of high-risk patients.
- Enhanced monitoring and prompt interventions are recommended for children with sepsis at high risk of developing PARDS.
Objective:
To identify early factors associated with pediatric acute respiratory distress syndrome (PARDS) within 48 hours after admission in children with sepsis and to develop and validate a combined prediction model.
Methods:
This retrospective cohort study included 547 children with sepsis admitted to the pediatric intensive care unit between June 2023 and December 2025 as the derivation cohort. Sepsis and PARDS were diagnosed according to the Phoenix and PALICC-2 criteria, respectively. Clinical data obtained within 2 hours of admission were analyzed. Correlation analysis, variance inflation factor assessment, and least absolute shrinkage and selection operator regression were followed by multivariable logistic regression to construct the final model. Performance was evaluated using the area under the receiver operating characteristic curve (AUC), Brier score, calibration assessment, and 1000 bootstrap resamples. An independent external cohort of 100 children, was used only to assess discrimination.
Results:
Among 547 children, 146 (26.7%) developed PARDS within 48 hours. Lower hemoglobin (OR = 0.987, 95% CI: 0.976-0.997), higher LAR (OR = 1.548, 95% CI: 1.042-2.299), septic shock (OR = 4.158, 95% CI: 2.001-8.639), and a higher Phoenix Sepsis Score (OR = 3.438, 95% CI: 2.603-4.540) were independently associated with early PARDS. The model achieved an AUC of 0.911 (95% CI: 0.882-0.939) in the derivation cohort. The apparent and optimism-corrected C-indices were 0.911 and 0.908, respectively, and the corresponding Brier scores were 0.0968 and 0.0995. In the external cohort, the AUC was 0.873 (95% CI: 0.775-0.970).
Conclusion:
Elevated LAR, higher Phoenix Sepsis Score, septic shock, and lower HB levels were important risk-related factors for the development of PARDS in pediatric sepsis. Enhanced dynamic monitoring and early interventions should be implemented for high-risk patients to improve clinical outcomes.
