Acute respiratory failure-related excess mortality in pediatric sepsis

Abstract

Excess mortality risk imparted by acute respiratory failure in children is unknown. We determined excess mortality risk associated with mechanically ventilated acute respiratory failure in pediatric sepsis. Novel ICD10-based algorithms were derived and validated to identify a surrogate for acute respiratory distress syndrome to calculate excess mortality risk. Algorithm-identified ARDS was identified with specificity of 96.7% (CI 93.0 - 98.9) and sensitivity of 70.5% (CI 44.0 - 89.7). Excess risk of mortality for ARDS was 24.4% (CI 22.9 - 26.2). Development of ARDS requiring mechanical ventilation imparts modest excess risk of mortality in septic children.

Keywords: ARDS; Critical Care; Paediatric Lung Disaese.

Figure 1

Kaplan-Meier Survival Curve for Children with Respiratory Diagnoses without Sepsis, Septic Children, and Septic Children with ARDS. The unadjusted Kaplan-Meier survival curves, censored at 28 days, for each diagnosis category are presented. The Log-rank test for trend is presented showing the significant difference between survival for each level of diagnosis category. Patient and hospital factor adjusted Cox proportional hazard ratios are presented next to the diagnostic categories’ representative survival curve. Excess risk of mortality represents the proportion of deaths in children with algorithm-identified ARDS in the septic population.