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Clinical MedicineIn-Press PreviewInflammationPulmonology Open Access | 10.1172/JCI177896
1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
Find articles by Till, J. in: JCI | PubMed | Google Scholar
1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
Find articles by Mai, M. in: JCI | PubMed | Google Scholar
1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
Find articles by Zhou, W. in: JCI | PubMed | Google Scholar
1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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1Division of Pediatric Critical Care, Department of Anesthesiology and Criti, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
2Division of Pediatric Cardiac Critical Care Medicine, Children’s Heart Inst, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, United States of America
3Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
4Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Ce, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America
6Division of Pediatric Hematology and Oncology, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, United States of America
8Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America
9Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, United States of America
10Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, United States of America
11Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PHILADELPHIA, United States of America
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Published April 4, 2024 - More info
BACKGROUND. The molecular signature of pediatric acute respiratory distress syndrome (ARDS) is poorly described, and the degree to which hyperinflammation or specific tissue injury contributes to outcomes is unknown. Therefore, we profiled inflammation and tissue injury dynamics over the first 7 days of ARDS, and associated specific biomarkers with mortality, persistent ARDS, and persistent multiple organ dysfunction syndrome (MODS).
METHODS. In a single-center prospective cohort of intubated pediatric ARDS, we collected plasma on days 0, 3, and 7. Nineteen biomarkers reflecting inflammation, tissue injury, and damage associated molecular patterns were measured. We assessed the relationship between biomarkers and trajectories with mortality, persistent ARDS, or persistent MODS using multivariable mixed effect models.
RESULTS. In 279 subjects (64 [23%] non-survivors), hyperinflammatory cytokines, tissue injury markers, and DAMPs were higher in non-survivors. Survivors and non-survivors showed different biomarker trajectories. IL-1α, sTNFR1, ANG2, and SPD increased in non-survivors, while DAMPs remained persistently elevated. ANG2 and P3NP were associated with persistent ARDS, whereas multiple cytokines, tissue injury markers, and DAMPs were associated with persistent MODS. Corticosteroid use did not impact the association of biomarker levels or trajectory with mortality.
CONCLUSIONS. Pediatric ARDS survivors and non-survivors had distinct biomarker trajectories, with cytokines, endothelial and alveolar epithelial injury, and DAMPs elevated in non-survivors. Mortality markers overlapped with markers associated with persistent MODS, rather than persistent ARDS.