Evidence map›Paper›PMID 40242498›Full record

ArticleCHEST critical care2025

Derivation and Validation of a Clinical and Endothelial Biomarker Risk Model to Predict Persistent Pediatric Sepsis-Associated Acute Respiratory Dysfunction.

James G Williams, Jane E Whitney, Scott L Weiss, Brian M Varisco, Nadir Yehya, Mihir R Atreya, Sepsis Genomics Collaborative and the Children’s Hospital of Philadelphia Sepsis Investigators

Abstract read
In one paragraph

Article in CHEST critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Distinct Blood and Lung Proteins Drive Pulmonary Capillary Leak in Children With Severe Hypoxemic Respiratory Failure.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2026
    Observational
  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

James G WilliamsDivision of Critical Care Medicine and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
Jane E WhitneyDivision of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Scott L WeissDivision of Critical Care Medicine, Nemour's Children's Hospital, Wilmington, DE.
Brian M VariscoDivision of Critical Care Medicine and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
Nadir YehyaDivision of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Mihir R AtreyaDivision of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics University of Cincinnati, College of Medicine, Cincinnati, OH.
Sepsis Genomics Collaborative and the Children’s Hospital of Philadelphia Sepsis Investigators

Funding

Expanding Translational Science in ArkansasUM1TR004909 · NCATS · UNIV OF ARKANSAS FOR MED SCIS · PI Laura P James · 2024 to 2026
$11.7M
HOST RESPONSE TO TRAUMA RESEARCH TRAINING PROGRAMT32GM008478 · NIGMS · UNIVERSITY OF CINCINNATI · PI TIMOTHY A PRITTS, BASILIA ZINGARELLI · 1993 to 2026
$6.7M
Linking Endotypes and Outcomes in Pediatric Acute Respiratory Distress SyndromeR01HL148054 · NHLBI · CHILDREN'S HOSP OF PHILADELPHIA · PI YEHYA, NADIR · 2019 to 2023
$4.1M
Supplement for MIRA award_Wong_2021R35GM126943 · NIGMS · CINCINNATI CHILDRENS HOSP MED CTR · PI ALDER, MATTHEW N · 2018 to 2022
$2.7M
Chymotrypsin-like Elastase 1 in Lung Development and DiseaseR01HL141229 · NHLBI · CINCINNATI CHILDRENS HOSP MED CTR · PI ZINGARELLI, BASILIA · 2018 to 2022
$2.6M
Effect of Mitochondrial Quality Control on Systemic Inflammation and Organ Dysfunction in Pediatric SepsisR01HD102396 · NICHD · NEMOURS CHILDREN'S HOSPITAL, DELAWARE · PI WEISS, SCOTT L · 2020 to 2024
$2.3M
CTSA K12 Program at the University of Arkansas for Medical SciencesK12TR004924 · NCATS · UNIV OF ARKANSAS FOR MED SCIS · PI Jason Eli Farrar, Joshua Kennedy · 2024 to 2026
$2.3M
Translational approaches to unravel organ-specific microvascular endothelial responses in sepsis.R35GM155165 · NIGMS · CINCINNATI CHILDRENS HOSP MED CTR · PI Mihir R Atreya · 2024 to 2026
$1.2M
Mitochondrial Dysfunction in Pediatric SepsisK23GM110496 · NIGMS · CHILDREN'S HOSP OF PHILADELPHIA · PI WEISS, SCOTT L · 2015 to 2018
$723k
NCATS NIH HHS K12 TR004924NCATS NIH HHS UM1 TR004909NHLBI NIH HHS R01 HL141229NHLBI NIH HHS R01 HL148054NICHD NIH HHS R01 HD102396NIGMS NIH HHS K23 GM110496NIGMS NIH HHS R35 GM126943NIGMS NIH HHS R35 GM155165NIGMS NIH HHS T32 GM008478
6 · The paper itself

Abstract

backgroundSepsis-associated ARDS results in high morbidity and mortality in children. However, heterogeneity among patients makes identifying those at risk of persistent acute respiratory dysfunction challenging. Endothelial dysfunction is a key feature of ARDS pathophysiologic characteristics, contributing to lung injury in sepsis. Incorporating endothelial biomarkers into risk models may enhance prediction of those with persistent acute respiratory dysfunction. RESEARCH QUESTION: Can clinical variables and endothelial biomarkers measured early in the course of sepsis predict risk of persistent acute respiratory dysfunction among critically ill children? STUDY DESIGN AND

methodsThis was a multicenter derivation and single center test cohort study of prospectively enrolled children with sepsis. The derivation cohort was split into training and holdout validation sets. We trained TreeNet (Minitab, LLC) and classification and regression tree (CART) models using clinical and endothelial biomarkers measured on day 1 of septic shock to predict risk of sepsis-associated acute respiratory dysfunction (SA ARD) on day 3. The performance of the CART model was tested in the holdout validation data set and in the independent test cohort.

resultsIn the derivation (n = 625) and test (n = 162) cohorts, children with day 3 SA ARD showed increased mortality, length of mechanical ventilation, and PICU length of stay compared with those without. The TreeNet and CART models yielded comparable results. The variables included in the final CART model were presence of SA ARD on day 1, Pao

interpretationWe derived and validated predictive models incorporating clinical and endothelial biomarkers to identify pediatric patients with septic shock at high risk of persistent acute respiratory dysfunction. Pending prospective validation, such models may facilitate enrichment and targeted intervention in future clinical trials.

Indexed as

biomarkersendothelial dysfunctionprecision medicinesepsis-associated respiratory dysfunctionseptic shock

Identifiers

PMID40242498
PMCPMC12001826

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.