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Pediatrics

Research Snapshot Theater: Pulmonary, Pediatric I

(1188) Extrapulmonary Organ Dysfunction in Pediatric ARDS Using PELOD-2 Criteria

Sunday, February 23, 2025
9:45am – 10:45am Eastern Time
Location: Connections Central - RST 16

    First Author(s)

  • IS

    Indu Seeni, MD

    Children's Hospital Los Angeles, United States

    • Co-Author(s)

  • MK

    Margaret Klein, M.S.

    Biostatistician II
    Children's Hospital Los Angeles, United States

  • RK

    Robinder Khemani, MD, MS

    Associate Director of Research, Professor of Pediatrics
    Children's Hospital Los Angeles
    Los Angeles, California, United States

  • AB

    Anoopindar Bhalla, MD

    Associate Professor of Clinical Pediatrics
    Children's Hospital Los Angeles, USC
    Los Angeles, California, United States

Introduction:

Introduction: Most children with pediatric acute respiratory distress syndrome (PARDS) die with extrapulmonary organ dysfunction. We sought to describe extrapulmonary organ dysfunction at PARDS diagnosis using Pediatric Logistic Organ Dysfunction (PELOD-2) criteria and its association with mortality.

Methods:

Methods: Secondary analysis of a multicenter international prospective observational study of children with PARDS (PARDIE study). Extrapulmonary organ dysfunction was defined by PELOD-2 criteria on PARDS days 0-3. The neurologic score was not used due to patient sedation and PARDS severity replaced the respiratory score. Exclusion criteria were death within 24 hours and fixed, dilated pupils.

Results:

Results: There were 568 patients included with a median age of 3.5 years [IQR 0.8, 9.5], 23% had severe PARDS, 13% were immunosuppressed, with 13% mortality. Extrapulmonary organ dysfunction at PARDS diagnosis was present in 76% [cardiac (62%), renal (24%), hematologic (24%)]. Extrapulmonary organ dysfunction was more common in mild and severe PARDS (85%) than in moderate PARDS (62%).

In univariate analyses, hematologic organ dysfunction (scores of 2 and 3 versus a score of 0, p< 0.02), the sum of hematologic, cardiac, and renal PELOD scores (OR [per 1 unit increase] 1.3 [1.1, 1.3] and 3 extrapulmonary organ dysfunctions vs 0 (OR 3.2 [1.2, 8.7], p= 0.02) were associated with mortality at the time of PARDS diagnosis. Severe versus mild PARDS (OR 4.2 [2.1, 8.5], p< 0.0001) was also associated with mortality risk.

In multivariate analyses adjusting for PARDS severity and immunosuppression, no association remained between hematologic organ dysfunction (score 2 versus 0 OR 1.5 [0.6, 3.6], p=0.4, score 3 versus 0 OR 2.1 [0.7, 5.9]), sum hematologic, cardiac, and renal PELOD-2 scores (OR 1.1 [1.0, 1.3]), and number of extrapulmonary organ dysfunctions (OR 1.4 [0.4, 4.6]) and mortality risk. However, there was an association between severe PARDS and mortality versus mild PARDS (OR 3.6 [1.7, 7.7], p< 0.001).

Conclusions:

Conclusions: Extrapulmonary organ dysfunction per PELOD-2 was not associated with mortality risk after adjustment for PARDS severity and immunosuppression. Further research is required to characterize organ dysfunction in children with PARDS for mortality risk stratification.