Allergy Asthma Respir Dis.  2016 Jul;4(4):257-263. 10.4168/aard.2016.4.4.257.

Application of the Berlin definition in children with acute respiratory distress syndrome

• Kim SY
• Kim YH
• Sol IS
• Kim MJ
• Yoon SH
• Kim KW
• Sohn MH
• Kim KE

• KMID: 2346754
• DOI: http://doi.org/10.4168/aard.2016.4.4.257

Abstract

PURPOSE
The revised Berlin definition (BD) showed better predictive validity for mortality in adults with acute respiratory distress syndrome (ARDS). We examined the validity of BD for pediatric ARDS as compared to the American-European Consensus Conference definition (AECCD).
METHODS
This single-center, retrospective study included 127 patients aged 1 month to 19 years who were admitted to the medical intensive care unit due to acute lung injury (ALI, n=31) or ARDS (n=96) using the AECCD. All patient characteristics and mortality rates were compared between the individual severity groups according to the BD and AECCD.
RESULTS
Sixty-four patients (50%) died. Mortality rates increased across the severity groups according to both definitions (26% in mild, 42% in moderate, and 75% in severe by the BD [P<0.001]; 26% in ALI non-ARDS and 58% in ARDS by the AECCD [P=0.002]). The mortality risk increased only for 'severe ARDS' (hazard radio for mortality, 2.56; 95% confidence intervals [CI], 1.14-5.78; P=0.023) after adjusting for confounding factors. The BD better predicted mortality, with an integrated area under the receiver operating characteristic curve (iAUC) of 0.651 (95% CI, 0.571-0.725), than the AECCD, with an iAUC of 0.584 (95% CI, 0.523-0.637). The pediatric risk of mortality (PRISM) III and pediatric index of mortality 3 scores were significantly different across BD severity groups, whereas only PRISM III scores were different according to the AECCD.
CONCLUSION
The BD applied to children with ARDS. It could be adopted to severity classifications and predict pediatric ARDS mortality better than the AECCD.

Keyword

Acute respiratory distress syndrome; Child; Mortality; Validity

MeSH Terms

Acute Lung Injury
Adult
Berlin*
Child*
Classification
Consensus
Humans
Intensive Care Units
Mortality
Respiratory Distress Syndrome, Adult*
Retrospective Studies
ROC Curve

Figure

• 

  Fig. 1 Kaplan-Meier curves for mortality according American-European Consensus Conference (AECC) and Berlin definition severity classes. Survival according to the AECC (A) and Berlin (B) definition. (A) Solid and dashed lines represent acute lung injury (ALI) non-ARDS and acute respiratory distress syndrome (ARDS) classes, respectively. (B) Solid, dashed, and dotted lines represent mild, moderate, and severe ARDS, respectively. Significant differences are shown in both definitions (P= 0.004 and P< 0.001, respectively by Log-rank test).

• 

  Fig. 2 Predictive accuracy for mortality: integrated area under the curve (iAUC) by follow-up time. Solid and dotted lines represent the American-European Consensus Conference (AECC) definition and Berlin definition, respectively. The Berlin definition had better mortality predictions, with an iAUC of 0.651 (95% confidence interval [CI], 0.571–0.725), than the AECC definition, which had an iAUC of 0.584 (95% CI, 0.523–0.637).

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