Predictors of Poor Outcomes in Pediatric Sepsis-Induced ARDS: Prospective Cohort Study From an LMIC

Monday, March 23, 2026

11:30 AM - 12:30 PM Central Time

Location: Connections Central - RST 14

SI

Sidra Ishaque, MD, FC, PS

Aga Khan University Hospital, PAK

Disclosure(s): No relevant financial relationship(s) to disclose.
FG

Fiza S. Gagai, n/a

Final Year Medical Student
Aga Khan Univeristy Hospital, Pakistan

Disclosure information not submitted.
AA

Areesha Ahmer, n/a

Dr
Aga Khan Univeristy Hospital, Sindh, Pakistan

Disclosure information not submitted.
TF

Tehreem Fatima, n/a

Dr
Aga Khan Univeristy Hospital, Pakistan

Disclosure information not submitted.
AS

Ali Faisal F. Saleem, n/a

Associate Professor
Aga Khan Univeristy Hospital, Pakistan

Disclosure information not submitted.
ZK

Zaubina Kazi, n/a

Dr
Aga Khan University Hospital, Pakistan

Disclosure information not submitted.
AH

Aneeta Hotwani, n/a

Senior Research Manager
Aga Khan University Hospital, Pakistan

Disclosure information not submitted.
NY

Nadir Yehya, MD, MSCE

Children's Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.

Introduction: Pediatric ARDS (pARDS), often triggered by sepsis, carries a high mortality burden, particularly in resource-limited settings. While 75% of pediatric ARDS cases are sepsis-related, most predictive data derive from high-income countries. We hypothesized that simple clinical and laboratory markers collected early during ICU admission could predict poor outcomes in children with sepsis-induced ARDS in a lower-middle-income country (LMIC) setting.

Methods: This was a 3-year prospective cohort study (2021–2023) conducted in the PICU at Aga Khan University Hospital, Karachi, Pakistan. Children aged 1 month to 18 years with sepsis were enrolled and monitored for ARDS development and mortality. Demographic data, severity scores (PELOD-2, VIS), and laboratory parameters (platelet count, creatinine, lactate) were recorded. ARDS was diagnosed based on PALICC criteria. Logistic regression was used to identify independent predictors of ARDS development and mortality.

Results: Out of 128 septic patients, 44.2% developed ARDS within 96 hours, and overall mortality was 23.4%. Non-survivors were more likely to be immunocompromised (30% vs. 13.3%, p=0.03). Significant predictors of mortality included higher VIS at 24 hours (0.84 vs. 0.28, p< 0.001), elevated PELOD-2 scores (≥4 in 21.4% of non-survivors vs. 8.6% survivors), thrombocytopenia (117 vs. 193×10³/µL, p=0.044), elevated creatinine (1.70 vs. 0.87 mg/dL, p=0.015), and increased lactate levels (5.11 vs. 3.67 mmol/L, p=0.007). Higher FiO₂ requirements were also observed in non-survivors (p=0.023). On multivariate analysis, only lactate on Day 1 independently predicted ARDS development (OR 1.21, p=0.018).

Conclusions: In LMIC PICUs, simple early markers—especially lactate, platelet count, and VIS—can aid in identifying children at high risk for ARDS and mortality. These low-cost indicators can guide early escalation in care, improve triage, and help validate context-specific severity scoring tools in resource-constrained settings.