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Association between Age and Mortality in Pediatric and Adult Acute Respiratory Distress Syndrome.
Pubmed ID: 38306669
Pubmed Central ID: PMC10995578
Journal: American journal of respiratory and critical care medicine
Publication Date: April 1, 2024
MeSH Terms: Humans, Adult, Aged, Aged, 80 and over, Algorithms, Adolescent, Middle Aged, Young Adult, Child, Retrospective Studies, Hospital Mortality, Child, Preschool, Hypoxia, Respiratory Distress Syndrome
Grants: R00 HL141678, R01 HL148054, R35 HL161196, R01 HL155159, R01 HL168202
Authors: Meyer NJ, Reilly JP, Yehya N, Harhay MO, Patel BM, Bhalla AK, Smith LS, Khemani RG, Jones TK
Cite As: Patel BM, Reilly JP, Bhalla AK, Smith LS, Khemani RG, Jones TK, Meyer NJ, Harhay MO, Yehya N. Association between Age and Mortality in Pediatric and Adult Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2024 Apr 1;209(7):871-878.
Studies:
- Acute Respiratory Distress Network (ARDSNet) Studies 01 and 03 Lower versus higher tidal volume, ketoconazole treatment and lisofylline treatment (ARMA/KARMA/LARMA)
- Acute Respiratory Distress Network (ARDSNet) Studies 06 and 08 Prospective, Randomized, Multicenter Trial of Aerosolized Albuterol Versus Placebo for the Treatment of Acute Lung Injury (ALTA)
- Acute Respiratory Distress Network (ARDSNet) Studies 07 and 08 Prospective, Randomized, Blinded, Placebo-controlled, Multi-center Trial of Omega-3 Fatty Acid, Gamma-Linolenic Acid, and Anti-Oxidant Supplementation in the Management of Acute Lung Injury or Acute Respiratory Distress Syndrome (Omega)
- Acute Respiratory Distress Network (ARDSNet) Studies 07, 08, 09, 11, and 12 Early Versus Delayed Enteral Feeding to Treat People with Acute Lung Injury or Acute Respiratory Distress Syndrome (EDEN)
- Acute Respiratory Distress Network (ARDSNet) Studies 10 and 12 Statins for Acutely Injured Lungs from Sepsis (SAILS)
- Acute Respiratory Distress Network (ARDSNet) Study 02 Late Steroid Rescue Study (LaSRS)
- Acute Respiratory Distress Network (ARDSNet) Study 04 Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury (ALVEOLI)
- Acute Respiratory Distress Network (ARDSNet) Study 05 Fluid and Catheter Treatment Trial (FACTT)
- Prevention and Early Treatment of Acute Lung Injury (PETAL) Network – Reevaluation of Systemic Early Neuromuscular Blockade (ROSE)
Abstract
<b>Rationale:</b> The epidemiology, management, and outcomes of acute respiratory distress syndrome (ARDS) differ between children and adults, with lower mortality rates in children despite comparable severity of hypoxemia. However, the relationship between age and mortality is unclear.<b>Objective:</b> We aimed to define the association between age and mortality in ARDS, hypothesizing that it would be nonlinear.<b>Methods:</b> We performed a retrospective cohort study using data from two pediatric ARDS observational cohorts (<i>n</i> = 1,236), multiple adult ARDS trials (<i>n</i> = 5,547), and an adult observational ARDS cohort (<i>n</i> = 1,079). We aligned all datasets to meet Berlin criteria. We performed unadjusted and adjusted logistic regression using fractional polynomials to assess the potentially nonlinear relationship between age and 90-day mortality, adjusting for sex, Pa<sub>O<sub>2</sub></sub>/Fi<sub>O<sub>2</sub></sub>, immunosuppressed status, year of study, and observational versus randomized controlled trial, treating each individual study as a fixed effect.<b>Measurements and Main Results:</b> There were 7,862 subjects with median ages of 4 years in the pediatric cohorts, 52 years in the adult trials, and 61 years in the adult observational cohort. Most subjects (43%) had moderate ARDS by Berlin criteria. Ninety-day mortality was 19% in the pediatric cohorts, 33% in the adult trials, and 67% in the adult observational cohort. We found a nonlinear relationship between age and mortality, with mortality risk increasing at an accelerating rate between 11 and 65 years of age, after which mortality risk increased more slowly.<b>Conclusions:</b> There was a nonlinear relationship between age and mortality in pediatric and adult ARDS.