Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA.
Pediatr Crit Care Med. 2024 Sep 1;25(9):816-827. doi: 10.1097/PCC.0000000000003552. Epub 2024 Jun 4.
To determine factors associated with health-related quality of life (HRQL) decline among pediatric acute respiratory distress syndrome (PARDS) survivors.
Retrospective cohort study.
Academic children's hospital.
Three hundred fifteen children 1 month to 18 years old with an unplanned PICU admission from December 2011 to February 2017 enrolled in the hospital's Outcomes Assessment Program.
None.
Pre-admission baseline and median 6-week post-discharge HRQL were assessed using the Pediatric Quality of Life Inventory or the Functional Status II-R. Patients meeting retrospectively applied Second Pediatric Acute Lung Injury Consensus Conference criteria for PARDS were identified, and PARDS severity was classified using binary (mild/moderate, severe) and trichotomous (mild, moderate, severe) categorization for noninvasive ventilation and invasive mechanical ventilation (IMV). PARDS occurred in 41 of 315 children (13.0%). Clinically important HRQL decline (≥ 4.5 points) occurred in 17 of 41 patients (41.5%) with PARDS and 64 of 274 without PARDS (23.4%). On multivariable generalized linear regression adjusted for age, baseline Pediatric Overall Performance Category, maximum nonrespiratory Pediatric Logistic Organ Dysfunction score, diagnosis, length of stay, and time to follow-up, PARDS was associated with HRQL decline (adjusted relative risk [aRR], 1.70; 95% CI, 1.03-2.77). Four-hour and maximum PARDS severity were the only factors associated with HRQL decline. HRQL decline occurred in five of 18 patients with mild PARDS at 4 hours, five of 13 with moderate PARDS (aRR 2.35 vs. no PARDS [95% CI, 1.01-5.50]), and seven of ten with severe PARDS (aRR 2.56 vs. no PARDS [95% CI, 1.45-4.53]). The area under the receiver operating characteristic curve for discrimination of HRQL decline for IMV patients was 0.79 (95% CI, 0.66-0.91) for binary and 0.80 (95% CI, 0.69-0.93) for trichotomous severity categorization.
HRQL decline is common among children surviving PARDS, and risk of decline is associated with PARDS severity. HRQL decline from baseline may be an efficient and clinically meaningful endpoint to incorporate into PARDS clinical trials.
确定与儿科急性呼吸窘迫综合征 (PARDS) 幸存者健康相关生活质量 (HRQL) 下降相关的因素。
回顾性队列研究。
学术儿童医院。
2011 年 12 月至 2017 年 2 月期间，315 名年龄在 1 个月至 18 岁之间、计划外入住儿科重症监护病房的儿童，参加了医院的预后评估计划。
无。
使用儿科生活质量量表或功能状态 II-R 评估入院前基线和中位 6 周的出院后 HRQL。回顾性应用第二版小儿急性肺损伤共识会议标准确定 PARDS 患儿，并使用无创通气和有创机械通气的二分类 (轻度/中度、重度) 和三分位 (轻度、中度、重度) 对 PARDS 严重程度进行分类。315 名儿童中 41 名 (13.0%)发生 PARDS。PARDS 患儿中 17 名 (41.5%)和 274 名无 PARDS 患儿中 64 名 (23.4%)发生临床意义显著的 HRQL 下降 (≥4.5 分)。多变量广义线性回归校正年龄、基线儿科整体表现类别、最大非呼吸儿科逻辑器官功能障碍评分、诊断、住院时间和随访时间后，PARDS 与 HRQL 下降相关 (调整后的相对风险 [aRR]，1.70；95%CI，1.03-2.77)。4 小时和最大 PARDS 严重程度是唯一与 HRQL 下降相关的因素。4 小时时，18 名轻度 PARDS 患儿中有 5 名、13 名中度 PARDS 患儿中有 5 名 (aRR 2.35 与无 PARDS [95%CI，1.01-5.50])和 10 名重度 PARDS 患儿中有 7 名 (aRR 2.56 与无 PARDS [95%CI，1.45-4.53])发生 HRQL 下降。用于区分 IMV 患者 HRQL 下降的接受者操作特征曲线下面积为二元分类的 0.79(95%CI，0.66-0.91)和三分位严重程度分类的 0.80(95%CI，0.69-0.93)。
PARDS 幸存者中 HRQL 下降很常见，下降风险与 PARDS 严重程度相关。与基线相比的 HRQL 下降可能是纳入 PARDS 临床试验的有效且具有临床意义的终点。
