Potential risk factors of pediatric acute respiratory distress syndrome in sepsis

  • Kezia Theofani Saragih Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
  • Ririe Fachrina Malisie Department of Child Health, Medical Faculty of Universitas Sumatera Utara/Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia https://orcid.org/0000-0002-5579-7999
  • Rini Savitri Daulay Department of Child Health, Medical Faculty of Universitas Sumatera Utara/Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia https://orcid.org/0000-0002-0215-7955
  • Bobby Ramses Erguna Sitepu Department of Ophthamology, Medical Faculty of Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
Keywords: ARDS; pediatric sepsis; risk factors

Abstract

Background Sepsis in children is characterized by a dysregulated host response to infection and life-threatening organ dysfunction. Pediatric acute respiratory distress syndrome (PARDS) is a severe complication of sepsis. Several known risk factors of PARDS are immunodeficiency, obesity, source of infection, and genetic factors.

Objective To describe the potential risk factors of PARDS in  septic children at Haji Adam Malik General Hospital, Medan, North Sumatera.

Methods This descriptive study using eligible medical record data from sepsis patients aged 1 month – 18 years was conducted at Haji Adam Malik General Hospital in 2020–2022. A total sampling method was used for subject selection. Patients’ demographic and clinical characteristics, mechanical ventilation modes and parameters, laboratory results, and outcomes were collected from medical records.  Patients were classified as having sepsis with PARDS if Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria of ARDS was met.

Results Of 112 pediatric sepsis patients, 33.9% developed PARDS. The mortality rates for PARDS was 73.7%. Of the patients with PARDS, 57.9% had immunodeficiency, 60.5% patients had an intrapulmonary infection, 39.5% had an extrapulmonary infection, and 23.7% of patients had a suspected genetic disorder. In addition, 39.5% had good nutritional status, followed by 21.1% with obese.

Conclusion The majority of patients with PARDS have intrapulmonary infection and immunodeficiency. Some of patients with PARDS have suspected genetic disorders and well nourished.

References

1. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving Sepsis Campaign International Guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21:e52-106. DOI: https://doi.org/10.1097/PCC.0000000000002198
2. Kohne JG, Flori HR. Risk factors and etiologies of pediatric acute respiratory distress syndrome. In: Shein S, Rotta A, editorS. Pediatric acute respiratory distress syndrome a clinical guide. Cham: Springer; 2020. p. 33–46. DOI: https://doi.org/10.1007/978-3-030-21840-9_4
3. Khemani RG, Smith LS, Zimmerman JJ, Erickson S, Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S23–40. DOI: https://doi.org/10.1097/PCC.0000000000000432
4. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395:200–11. DOI: https://doi.org/10.1016/S0140-6736(19)32989-7
5. Sudarmono P, Aman AT, Arif M, Syarif AK, Kosasih H, Karyana M, et al; Southeast Asia Infectious Disease Clinical Research Network. Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study. Lancet Glob Health. 2017;5:e157–67. DOI: https://doi.org/10.1016/S2214-109X(17)30007-4
6. Pratiwi R. Profil pasien sepsis di ruang rawat intensif anak RSUP Haji Adam Malik Medan dan RS Universitas Sumatera Utara Tahun 2018 [Undergraduate Thesis]. Medan: Universitas Sumatera Utara; 2019.
7. Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med. 2019;7:115–28. DOI: https://doi.org/10.1016/S2213-2600(18)30344-8
8. Wong JJM, Phan HP, Phumeetham S, Ong JSM, Chor YK, Qian S, et al. Risk stratification in pediatric acute respiratory distress syndrome: a multicenter observational study. Crit Care Med. 2017;45:1820–8. DOI: https://doi.org/10.1097/CCM.0000000000002623
9. Ayunda D, Malisie RF, Hasby AY. The etiologies of pediatric acute respiratory distress syndrome (PARDS) in patients treated at the PICU of Haji Adam Malik Hospital Medan in 2017 – 2020. J Endocrinol Trop Med Infect Dis. 2022;4:11–21. DOI: https://doi.org/10.32734/jetromi.v4i1.8016
10. Yehya N, Thomas NJ. Sepsis and pediatric acute respiratory distress syndrome. J Pediatr Intensive Care. 2019;8:32–41. DOI: https://doi.org/10.1055/s-0038-1676133
11. Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 2 Tahun 2020 Tentang Standar Antropometri Anak. Jakarta: Kemenkes RI; 2020. [cited 2024 April 14].
12. WHO. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. [cited 2024 April 14]. Available from: https://www.who.int/publications/i/item/924154693X
13. Rusmawatiningtyas D, Rahmawati A, Makrufardi F, Mardhiah N, Murni IK, Uiterwaal CSPM, et al. Factors associated with mortality of pediatric sepsis patients at the pediatric intensive care unit in a low-resource setting. BMC Pediatr. 2021;21:471. DOI: https://doi.org/10.1186/s12887-021-02945-0
14. Angele MK, Pratschke S, Hubbard WJ, Chaudry IH. Gender differences in sepsis: cardiovascular and immunological aspects. Virulence. 2014;5:12–9. DOI: https://doi.org/10.4161/viru.26982
15. Prout AJ, Talisa VB, Carcillo JA, Mayr FB, Angus DC, Seymour CW, et al. Children with chronic disease bear the highest burden of pediatric sepsis. J Pediatr. 2018;199:194-199.e1. DOI: https://doi.org/10.1016/j.jpeds.2018.03.056
16. Saraswati DD, Pudjiadi AH, Djer MM, Supriyatno B, Syarif DR, Kurniati N. Faktor risiko yang berperan pada mortalitas sepsis. Sari Pediatr. 2014;15:281-8. DOI: https://doi.org/10.14238/sp15.5.2014.281-8
17. Profil sepsis anak di pediatric intensive care unit Rumah Sakit Umum Pusat Sanglah Denpasar-Bali. Sari Pediatr. 2019;21:152–8. DOI: https://doi.org/10.14238/sp21.3.2019.152-8
18. Mathias B, Mira JC, Larson SD. Pediatric sepsis. Curr Opin Pediatr. 2016;28:380–7. DOI: https://doi.org/10.1097/MOP.0000000000000337
19. Hermon MM, Etmayr T, Brandt JB, Sadeghi K, Burda G, Golej J. Pediatric infection and sepsis in five age subgroups: single-center registry. Wien Med Wochenschr. 2021;171:29–35. DOI: https://doi.org/10.1007/s10354-020-00787-6
20. Jabornisky R, Sáenz SS, Capocasa P, Jaen R, Moreno RP, Landry L, et al. Epidemiological study of pediatric severe sepsis in Argentina. Arch Argent Pediatr. 2019;117:S135–56. DOI: https://doi.org/10.5546/aap.2019.eng.S135.
21. Humoodi MO, Aldabbagh MA, Salem MM, Al Talhi YM, Osman SM, Bakhsh M, et al. Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia. BMC Pediatr. 2021;21:222. DOI: https://doi.org/10.1186/s12887-021-02686-0
22. Yuan X, Li S, Zhou L, Tang T, Cheng Y, Ao X, et al. Diagnostic accuracy of plasma ghrelin concentrations in pediatric sepsis-associated acute respiratory distress syndrome: a single-center cohort study. Front Pediatr. 2021;9:664052. DOI: https://doi.org/10.3389/fped.2021.664052
23. Yu WL, Lu ZJ, Wang Y, Shi LP, Kuang FW, Qian SY, et al. The epidemiology of acute respiratory distress syndrome in pediatric intensive care units in China. Intensive Care Med. 2009;35:136–43. DOI: https://doi.org/10.1007/s00134-008-1254-x
24. Yehya N, Harhay MO, Klein MJ, Shein SL, Piñeres-Olave BE, Izquierdo L, et al. Predicting mortality in children with pediatric acute respiratory distress syndrome: a pediatric acute respiratory distress syndrome incidence and epidemiology study. Crit Care Med. 2020;48:E514–22. DOI: https://doi.org/10.1097/CCM.0000000000004345
25. Zhou L, Li S, Tang T, Yuan X, Tan L. A single-center PICU present status survey of pediatric sepsis-related acute respiratory distress syndrome. Pediatr Pulmonol. 2022;57:2003-11. DOI: https://doi.org/10.1002/ppul.25943
26. Flori H, Dahmer MK, Sapru A, Quasney MW, Pediatric Acute Lung Injury Consensus Conference Group. Comorbidities and assessment of severity of pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16:S41–50. DOI: https://doi.org/10.1097/PCC.0000000000000430
27. Rowan CM. Pediatric acute respiratory distress syndrome in immunocompromised patients. In: Shein S, Rotta A, editors. Pediatric acute respiratory distress syndrome a clinical guide. Cham: Springer; 2020. p. 181-92. DOI: https://doi.org/10.1007/978-3-030-21840-9_15.
28. Song M, Liu Y, Lu Z, Luo H, Peng H, Chen P. Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency. BMC Pulm Med. 2020;20:102. DOI: https://doi.org/10.1186/s12890-020-1131-0
29. de Farias ECF, Pavão Júnior MJC, Dias LG, da Silva ER, Rocha RSB, Cunha K da C, et al. Risk factors in acute respiratory distress syndrome among children with cancer in Brazilian Amazon: an observational study. Res Soc Dev. 2021;10:e41710917767. DOI: https://doi.org/10.33448/rsd-v10i9.17767
30. Arduini RG, de Araujo OR, da Silva DCB, Senerchia AA, Petrilli AS. Sepsis-related acute respiratory distress syndrome in children with cancer: the respiratory dynamics of a devastating condition. Rev Bras Ter Intensiva. 2016;28:436–43. DOI: https://doi.org/10.5935/0103-507X.20160077
31. Ward SL, Gildengorin V, Valentine SL, Sapru A, Curley MAQ, Thomas N, et al. Impact of weight extremes on clinical outcomes in pediatric acute respiratory distress syndrome. Crit Care Med. 2016;44:2052–9. DOI: https://doi.org/10.1097/CCM.0000000000001857
32. De Jong A, Verzilli D, Jaber S. ARDS in obese patients: specificities and management. Crit Care. 2019;23:74. DOI: https://doi.org/10.1186/s13054-019-2374-0
33. Gong MN, Bajwa EK, Thompson BT, Christiani DC. Body mass index is associated with the development of acute respiratory distress syndrome. Thorax. 2010;65:44–50. DOI: https://doi.org/10.1136/thx.2009.117572
34. Guo Z, Wang X, Wang Y, Xing G, Liu S. “Obesity paradox” in acute respiratory distress syndrome: Asystematic review and meta-analysis. PLoS One. 2016;11:e0163677. DOI: https://doi.org/10.1371/journal.pone.0163677
35. Ross PA, Klein MJ, Nguyen T, Leung D, Khemani RG, Newth CJL, et al. Body habitus and risk of mortality in pediatric sepsis and septic shock: a retrospective cohort study. J Pediatr. 2019;210:178-83.e2. DOI: https://doi.org/10.1016/j.jpeds.2019.03.027
36. Whitney JE, Feng R, Koterba N, Chen F, Bush J, Graham K, et al. Endothelial biomarkers are associated with indirect lung injury in sepsis-associated pediatric acute respiratory distress syndrome. Crit Care Explor. 2020;2:e0295. DOI: https://doi.org/10.1097/CCE.0000000000000295
37. Englert JA, Bobba C, Baron RM. Integrating molecular pathogenesis and clinical translation in sepsis-induced acute respiratory distress syndrome. JCI Insight. 2019;4:e124061. DOI: https://doi.org/10.1172/jci.insight.124061
38. Bruijn M, Van Der Aa LB, Van Rijn RR, Bos AP, Van Woensel JBM. High incidence of acute lung injury in children with Down syndrome. Intensive Care Med. 2007;33:2179–82. DOI: https://doi.org/10.1007/s00134-007-0803-z
39. Bruijn M, Lutter R, Eldering E, Bos AP, Van Woensel JBM. Effect of oxidative stress on respiratory epithelium from children with Down syndrome. Eur Respir J. 2013;42:1037–45. DOI: https://doi.org/10.1183/09031936.00122812
Published
2024-05-28
How to Cite
1.
Saragih K, Malisie R, Daulay R, Sitepu B. Potential risk factors of pediatric acute respiratory distress syndrome in sepsis. PI [Internet]. 28May2024 [cited 15Jul.2024];64(3):193-01. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/3342
Section
Emergency & Pediatric Intensive Care
Received 2023-01-14
Accepted 2024-05-28
Published 2024-05-28