Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children
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Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is apragmatic decision based on the degree of hypoxia at the time of onset. We aimed todetermine whether reclassification using oxygenation metrics 24 hours after diagnosis couldprovide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1,2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectivelyanalyzed. Reclassification based on data measured 24 hours after diagnosis was comparedwith the initial classification, and changes in pressure parameters and oxygenation wereinvestigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed animprovement, 35.4% showed no change, and 12.2% either showed progression of PARDS ordied. Multivariate analysis revealed that mortality risk significantly increased for the severegroup, based on classification using metrics collected 24 hours after diagnosis (adjusted oddsratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes inpressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation(arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showedstatistically better discriminative power for mortality (area under the receiver operating characteristiccurve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours afterdiagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours wassignificantly associated with outcomes in PARDS, and oxygenation response was the mostdiscernable surrogate metric for mortality.
Abstract
Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is apragmatic decision based on the degree of hypoxia at the time of onset. We aimed todetermine whether reclassification using oxygenation metrics 24 hours after diagnosis couldprovide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1,2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectivelyanalyzed. Reclassification based on data measured 24 hours after diagnosis was comparedwith the initial classification, and changes in pressure parameters and oxygenation wereinvestigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed animprovement, 35.4% showed no change, and 12.2% either showed progression of PARDS ordied. Multivariate analysis revealed that mortality risk significantly increased for the severegroup, based on classification using metrics collected 24 hours after diagnosis (adjusted oddsratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes inpressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation(arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showedstatistically better discriminative power for mortality (area under the receiver operating characteristiccurve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours afterdiagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours wassignificantly associated with outcomes in PARDS, and oxygenation response was the mostdiscernable surrogate metric for mortality.
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