Unraveling mortality risk in pediatric acute respiratory distress syndrome: key biomarkers and pathophysiological insights.

Pediatric Acute Respiratory Distress Syndrome (PARDS) remains a major cause of morbidity and mortality in critically ill children. Limited disease-specific pharmacological therapies and substantial clinical and biological heterogeneity may contribute to suboptimal treatment responses. Biomarkers associated with mortality risk during disease onset and progression may improve prognostic stratification and inform future therapeutic strategies. This narrative review systematically identified relevant literature through a structured PubMed search conducted between March 1, 2024, and January 1, 2025, yielding 33 eligible studies evaluating clinically investigated biomarkers associated with mortality and disease severity in PARDS. The findings highlight multiple biomarker domains, including inflammatory mediators, endothelial injury markers, and epithelial damage indicators that are associated with adverse outcomes. However, significant challenges remain regarding standardization, validation, and clinical implementation. Further translational and prospective studies are needed to determine whether biomarker-guided approaches can improve clinical decision-making and outcomes in PARDS. IMPACT: Pediatric Acute Respiratory Distress Syndrome (PARDS) is a globally serious concern with a significant morbidity and mortality in children. Identifying key biomarkers that can predict disease trajectory, and outcomes can guide in treatment decision-making. Further exploration of these key biomarkers and their molecular steps can provide valuable insight into disease mechanism.