Acute and Critical Care

Original Articles

Pediatric
Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children: Soo Yeon Kim, Byuhree Kim, Sun Ha Choi, Jong Deok Kim, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim; Acute Crit Care. 2018;33(4):222-229. Published online November 29, 2018; DOI: https://doi.org/10.4266/acc.2018.00136

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Background
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide 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 retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
Results
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure 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 showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Conclusions
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

Citations

Citations to this article as recorded by

A single‐center PICU present status survey of pediatric sepsis‐related acute respiratory distress syndrome
Liang Zhou, Shaojun Li, Tian Tang, Xiu Yuan, Liping Tan
Pediatric Pulmonology.2022; 57(9): 2003. CrossRef

CPR/Resuscitation
Validation of Pediatric Index of Mortality 3 for Predicting Mortality among Patients Admitted to a Pediatric Intensive Care Unit: Jae Hwa Jung, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn; Acute Crit Care. 2018;33(3):170-177. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00150

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Abstract PDF

Background
The objective of this study was to evaluate the usefulness of the newest version of the pediatric index of mortality (PIM) 3 for predicting mortality and validating PIM 3 in Korean children admitted to a single intensive care unit (ICU).
Methods
We enrolled children at least 1 month old but less than 18 years of age who were admitted to the medical ICU between March 2009 and February 2015. Performances of the pediatric risk of mortality (PRISM) III, PIM 2, and PIM 3 were evaluated by assessing the area under the receiver operating characteristic (ROC) curve, conducting the Hosmer-Lemeshow test, and calculating the standardized mortality ratio (SMR).
Results
In total, 503 children were enrolled; the areas under the ROC curve for PRISM III, PIM 2, and PIM 3 were 0.775, 0.796, and 0.826, respectively. The area under the ROC curve was significantly greater for PIM 3 than for PIM 2 (P<0.001) and PRISM III (P=0.016). There were no significant differences in the Hosmer-Lemeshow test results for PRISM III (P=0.498), PIM 2 (P=0.249), and PIM 3 (P=0.337). The SMR calculated using PIM 3 (1.11) was closer to 1 than PIM 2 (0.84).
Conclusions
PIM 3 showed better prediction of the risk of mortality than PIM 2 for the Korean pediatric population admitted in the ICU.

Citations

Citations to this article as recorded by

Clinical Features and Management of Status Epilepticus in the Pediatric Intensive Care Unit
Ekin Soydan, Yigithan Guzin, Sevgi Topal, Gulhan Atakul, Mustafa Colak, Pinar Seven, Ozlem Sarac Sandal, Gokhan Ceylan, Aycan Unalp, Hasan Agin
Pediatric Emergency Care.2023; 39(3): 142. CrossRef
Evaluation of the Performance of PRISM III and PIM II Scores in a Tertiary Pediatric Intensive Care Unit
Büşra Uzunay Gündoğan, Oğuz Dursun, Nazan Ülgen Tekerek, Levent Dönmez
Turkish Journal of Pediatric Emergency and Intensive Care Medicine.2023; 10(1): 8. CrossRef
Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study
Jaeyoung Choi, Esther Park, Ah Young Choi, Meong Hi Son, Joongbum Cho
Journal of Korean Medical Science.2023;[Epub] CrossRef
Internal validation and evaluation of the predictive performance of models based on the PRISM-3 (Pediatric Risk of Mortality) and PIM-3 (Pediatric Index of Mortality) scoring systems for predicting mortality in Pediatric Intensive Care Units (PICUs)
Zahra Rahmatinejad, Fatemeh Rahmatinejad, Majid Sezavar, Fariba Tohidinezhad, Ameen Abu-Hanna, Saeid Eslami
BMC Pediatrics.2022;[Epub] CrossRef
Performance of Pediatric Risk of Mortality III and Pediatric Index of Mortality III Scores in Tertiary Pediatric Intensive Unit in Saudi Arabia
Ahmed S. Alkhalifah, Abdulaziz AlSoqati, Jihad Zahraa
Frontiers in Pediatrics.2022;[Epub] CrossRef
Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2
Eui Jun Lee, Bongjin Lee, You Sun Kim, Yu Hyeon Choi, Young Ho Kwak, June Dong Park
Acute and Critical Care.2022; 37(3): 454. CrossRef
Administrative data in pediatric critical care research—Potential, challenges, and future directions
Nora Bruns, Anna-Lisa Sorg, Ursula Felderhoff-Müser, Christian Dohna-Schwake, Andreas Stang
Frontiers in Pediatrics.2022;[Epub] CrossRef
Development of a machine learning model for predicting pediatric mortality in the early stages of intensive care unit admission
Bongjin Lee, Kyunghoon Kim, Hyejin Hwang, You Sun Kim, Eun Hee Chung, Jong-Seo Yoon, Hwa Jin Cho, June Dong Park
Scientific Reports.2021;[Epub] CrossRef
Meta-Analysis for the Prediction of Mortality Rates in a Pediatric Intensive Care Unit Using Different Scores: PRISM-III/IV, PIM-3, and PELOD-2
Yaping Shen, Juan Jiang
Frontiers in Pediatrics.2021;[Epub] CrossRef
Simplified Pediatric Index of Mortality 3 Score by Explainable Machine Learning Algorithm
Orkun Baloglu, Matthew Nagy, Chidiebere Ezetendu, Samir Q. Latifi, Aziz Nazha
Critical Care Explorations.2021; 3(10): e0561. CrossRef
Performance of Pediatric Index of Mortality in a Tertiary Care PICU in India
Nisha Toteja, Bharat Choudhary, Daisy Khera, Rohit Sasidharan, Prem Prakash Sharma, Kuldeep Singh
Journal of Pediatric Intensive Care.2021;[Epub] CrossRef

Pediatric
Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit: Young Suh Kim, In Suk Sol, Min Jung Kim, Soo Yeon Kim, Jong Deok Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim; Korean J Crit Care Med. 2017;32(4):347-355. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00437

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Abstract PDF Supplementary Material

Background
Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU).
Methods
Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded.
Results
The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/μl vs. 341,000/μl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively.
Conclusions
Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.

Citations

Citations to this article as recorded by

Prognostic factors and models to predict pediatric sepsis mortality: A scoping review
Irene Yuniar, Cut Nurul Hafifah, Sharfina Fulki Adilla, Arifah Nur Shadrina, Anthony Christian Darmawan, Kholisah Nasution, Respati W. Ranakusuma, Eka Dian Safitri
Frontiers in Pediatrics.2023;[Epub] CrossRef
The association between serum albumin and long length of stay of patients with acute heart failure: A retrospective study based on the MIMIC-IV database
Tao Liu, Haochen Xuan, Lili Wang, Xiaoqun Li, Zhihao Lu, Zhaoxuan Tian, Junhong Chen, Chaofan Wang, Dongye Li, Tongda Xu, Chiara Lazzeri
PLOS ONE.2023; 18(2): e0282289. CrossRef
Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS) and Serous Effusions in a Child With Severe Hypoalbuminemia: A Case Report
Zohair El Haddar, Aziza Elouali, Ilham Belga, Maria Rkain, Abdeladim Babakhouya
Cureus.2023;[Epub] CrossRef
Inappropriate empirical antibiotic therapy was an independent risk factor of pediatric persistent S. aureus bloodstream infection
Xingmei Wang, Ziyao Guo, Xi Zhang, Guangli Zhang, Qinyuan Li, Xiaoyin Tian, Dapeng Chen, Zhengxiu Luo
European Journal of Pediatrics.2022; 182(2): 719. CrossRef
Evaluation of models for predicting pediatric fraction unbound in plasma for human health risk assessment
Yejin Esther Yun, Andrea N. Edginton
Journal of Toxicology and Environmental Health, Part A.2021; 84(2): 67. CrossRef
Diabetes Mellitus and Hypertension Increase Risk of Death in Novel Corona Virus Patients Irrespective of Age: a Prospective Observational Study of Co-morbidities and COVID-19 from India
Anirban Gupta, Neelabh Nayan, Ranjith Nair, Krishna Kumar, Aditya Joshi, Shivangi Sharma, Jasdeep Singh, Rajan Kapoor
SN Comprehensive Clinical Medicine.2021; 3(4): 937. CrossRef
Overview of Albumin Physiology and its Role in Pediatric Diseases
Charles B. Chen, Bilasan Hammo, Jessica Barry, Kadakkal Radhakrishnan
Current Gastroenterology Reports.2021;[Epub] CrossRef
The effect of nutritional status on post-operative outcomes in pediatric otolaryngology-head and neck surgery
Jordan Luttrell, Matthew Spence, Hiba Al-Zubeidi, Michael J. Herr, Madhu Mamidala, Anthony Sheyn
International Journal of Pediatric Otorhinolaryngology.2021; 150: 110875. CrossRef

Hematology/Pediatric
Delta Neutrophil Index as a Prognostic Marker in the Pediatric Intensive Care Unit: In Suk Sol, Hyun Bin Park, Min Jung Kim, Seo Hee Yoon, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim; Korean J Crit Care Med. 2016;31(4):351-358. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00171

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Abstract PDF

Background
The delta neutrophil index (DNI) is a useful marker for diagnosing and predicting the prognosis of sepsis. The purpose of this study was to investigate the usefulness of DNI as a prognostic marker in patients within the pediatric intensive care unit (PICU), as well as its association with other prognostic factors.
Methods
A total of 516 children admitted to Severance Children’s Hospital PICU from December 2009 to February 2015 were analyzed. DNI was measured on the day of PICU admission. Mortality was defined as death within 28 days following PICU admission.
Results
The median value of DNI was 1.2% (interquartile range [IQR] 0-4.3%) in the survivor group and 9.5% (IQR 2.3-20.8%) in the non-survivor group, and the difference was statistically significant (p < 0.001). DNI was significantly positively correlated with ICU scores such as Pediatric Index of Mortality 3 and Pediatric Risk of Mortality III, as well as with C-reactive protein and lactate levels. The area under the receiver operating characteristic curve of DNI for mortality was 0.748 (95% CI: 0.687-0.808) and the cut-off value was 4.95%.
Conclusions
The initial DNI level can be considered a useful indicator for predicting prognosis in PICU patients.

Citations

Citations to this article as recorded by

Performance Comparison of Procalcitonin, Delta Neutrophil Index, C-Reactive Protein, and Serum Amyloid A Levels in Patients with Hematologic Diseases
Jooyoung Cho, Jong-Han Lee, Dong Hyun Lee, Juwon Kim, Young Uh
Diagnostics.2023; 13(7): 1213. CrossRef
Potential and promising marker for serious bacterial infections in children: Delta neutrophil index
Metin Yigit, Aslinur Ozkaya‐Parlakay, Naci Yilmaz, Ozhan Akyol, Belgin Gulhan, Saliha Kanik Yuksek, Basak Yalcin Burhan, Enes K Kilic, Cuneyt Karagol
Journal of Paediatrics and Child Health.2022; 58(9): 1623. CrossRef
Delta Neutrophil Index as a Diagnostic Marker of Neonatal Sepsis
Nuriye Asli Melekoglu, Seyma Yasar, Mehmet Keskin
Journal of Pediatric Infectious Diseases.2021; 16(03): 099. CrossRef
Prognostic value of the delta neutrophil index in pediatric cardiac arrest
Seo Hee Yoon, Eun Ju Lee, Jinae Lee, Moon Kyu Kim, Jong Gyun Ahn
Scientific Reports.2020;[Epub] CrossRef

Usefulness of Thrombocytopenia and Changes in Platelet Counts as Prognostic Markers in Pediatric Intensive Care Units: Yoon Hee Kim, Hyun Bin Park, Min Jung Kim, Hwan Soo Kim, Hee Seon Lee, Yoon Ki Han, Kyung Won Kim, Myung Hyun Sohn, Kyu Earn Kim; Korean J Crit Care Med. 2013;28(2):93-100.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.93

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Abstract PDF: BACKGROUND
Thrombocytopenia has been shown to be a useful predictor of mortality in adult intensive care units (ICUs). The aim of this study is to assess whether the level of platelet count at ICU admission and the changes in platelet counts can predict mortality in the pediatric ICU (PICU).
METHODS
Platelet counts were checked daily for at least 4 days in a total of 303 children who were admitted to the ICU. We compared the initial platelet counts and changes in platelet counts between survivors and non-survivors. A multivariable logistic regression model, a receiver operating characteristic curve and a linear mixed model were used.
RESULTS
The initial platelet count was significantly lower in non-survivors when compared to survivors. Multivariate analysis demonstrated that platelet count <120 x 10(9)/L (Odds ratio, 4.913; 95% confidence interval 2.451-9.851; p < 0.0001) was an independent predictor of mortality. In the case of children with thrombocytopenia (<120 x 10(9)/L) at admission to the ICU, the platelet counts increased serially in survivors, whereas non-survivors maintained their decreased platelet counts. In the case of children without thrombocytopenia, the platelet counts decreased most on day 3 in non-survivors.
CONCLUSIONS
At admission to the ICU, thrombocytopenia defined as a platelet count <120 x 10(9)/L can be a useful predictor of mortality in children. In children who had initial thrombocytopenia, the serial increase of platelet counts can be related to increased survival, whereas in children who did not have initial thrombocytopenia, more than a 10% decrease of platelet counts on day 3 can be related to mortality.

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