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Allergy Asthma Respir Dis. 2019 Jan;7(1):44-50. Korean.
Published online Jan 30, 2019.  https://doi.org/10.4168/aard.2019.7.1.44
© 2019 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Clinical application of the Pediatric Acute Lung Injury Consensus Conference definition of acute respiratory distress syndrome
Byuh Ree Kim,1 Soo Yeon Kim,1 In Suk Sol,1 Yoon Hee Kim,1 Kyung Won Kim,1 Myung Hyun Sohn,1 and Kyu-Earn Kim2
1Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
2Sowha Children's Hospital, Seoul, Korea.

Correspondence to: Soo Yeon Kim. Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-2050, Fax: +82-2-393-9118, Email: sophi1@yuhs.ac
Received Aug 28, 2018; Revised Oct 18, 2018; Accepted Oct 18, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).


Abstract

Purpose

Despite improved quality of intensive care, acute respiratory distress syndrome (ARDS) significantly contributes to mortality in critically ill children. As pre-existing definitions of ARDS were adult-oriented standards, the Pediatric Acute Lung Injury Consensus Conference (PALICC) group released a new definition of pediatric ARDS. In this study, we aimed to assess the performance of PALICC definition for ARDS risk stratification.

Methods

Total 332 patients who admitted to the intensive care unit at Severance Hospital from January 2009 to December 2016 and diagnosed as having ARDS by either the PALICC definition or the Berlin definition were retrospectively analyzed. Patient characteristics and mortality rates were compared between the individual severity groups according to both definitions.

Results

The overall mortality rate was 36.1%. The mortality rate increased across the severity classes according to both definitions (26% in mild, 37% in moderate and 68% in severe by the PALICC definition [P<0.001]; 20% in mild, 32% in moderate and 64% in severe by the Berlin definition [P<0.001]). The mortality risk increased only for severe ARDS in both definitions (hazard ratio [95% confidence interval]: 2.279 [1.414–3.672], P=0.001 by the PALICC definition; 2.674 [1.518–4.712], P=0.001 by the Berlin definition). There was no significant difference in mortality discrimination between the 2 definitions (difference in integrated area under the curve: 0.017 [−0.018 to 0.049]).

Conclusion

The PALICC definition demonstrated similar discrimination power on PARDS' severity and mortality as the Berlin definition.

Keywords: Pediatric acute respiratory distress syndrome; Pediatric Acute Lung Injury Consensus Conference; Berlin definition; Mortality

SUPPLEMENTARY MATERIAL
Supplementary Fig. 1

Distribution of patients according to Pediatric Acute Lung Injury Consensus Conference (PALICC) and Berlin definition. PARDS, pediatric acute respiratory distress syndrome.

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Figures


Fig. 1
Kaplan-Meier survival curves for mortality according to Pediatric Acute Lung Injury Consensus Conference (PALICC) (A) and Berlin definition severity group (B). (A) Black line represents mild acute respiratory distress syndrome (ARDS), gray line represents moderate ARDS, and light gray line represents severe ARDS. (B) Black, gray, and light gray lines represent mild, moderate, and severe ARDS, respectively.
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Fig. 2
Predictive accuracy for mortality: integrated area under the curve (iAUC) by follow-up time. Solid and dotted lines represent the Pediatric Acute Lung Injury Consensus Conference (PALICC) and Berlin definition respectively.
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Tables


Table 1
Demographics of patients with pediatric acute respiratory distress syndrome
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Table 2
Clinical characteristics and physiologic variables of patients across severity categories using the PALICC definition and the Berlin definition
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Table 3
Multivariate analysis using Cox model for mortality
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Notes

This work was supported by Institute for Information & communications Technology Promotion (IITP) grant funded by the Korea government (MSIT) (No. 2017-0-00599, Development of Big Data Analytics Platform for Military Health Information).

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