Inflammatory and Comorbid Features of Children Admitted to a PICU for Status Asthmaticus

Objectives: To determine risk factors associated with admission to a PICU with or without endotracheal intubation for an asthma exacerbation. We hypothesized that children with critical and near-fatal asthma would have distinguishing clinical features but varying degrees of asthma severity and measures of type 2 inflammation. Design: Retrospective analysis of prospectively collected data of children with asthma recruited into outpatient asthma clinical research studies at Emory University between 2004 and 2015. Setting: Large, free-standing academic quaternary care children’s hospital in Atlanta, GA. Patients: Children 6–18 years old with physician-diagnosed and confirmed asthma. Interventions: None. Measurements and Main Results: A total of 579 children were analyzed with 170 children (29.4%) being admitted to the PICU for an asthma exacerbation in their lifetime. Of these 170 children with a history of critical asthma, 24.1% were classified as having mild-to-moderate asthma, and 83 of 170 children (48.8%) had been intubated and experienced near-fatal asthma. Multiple logistic regression was used to identify risk factors associated with increased odds of PICU admission with or without endotracheal intubation. Hospitalization within the prior 12 months of survey (odds ratio, 8.19; 95% CI, 4.83–13.89), a history of pneumonia (odds ratio, 2.56; 95% CI, 1.52–4.29), having a designation of increased chronic asthma severity on high-dose inhaled corticosteroids (odds ratio, 2.76; 95% CI, 1.62–4.70), having a father with asthma (odds ratio, 2.15; 95% CI, 1.23–3.76), living in a region with a higher burden of poverty (odds ratio, 1.28; 95% CI, 1.02–1.61), and being of black race (odds ratio, 2.01; 95% CI, 1.05–3.84) were all associated with increased odds of PICU admission with or without intubation. Conclusions: Our findings suggest that there are factors associated with critical and near-fatal asthma, distinct from the chronic asthma severity designations, that should be the focus of future investigation. Drs. Grunwell and Fitzpatrick conceived and developed the study. Dr. Grunwell drafted the article. Dr. Travers helped to develop the study, conducted statistical analyses, and helped to interpret the data. Drs. Grunwell, Travers, and Fitzpatrick edited the article. All authors read and approved the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Supported, in part, by R01 NR013700, the National Center for Advancing Translational Sciences of the National Institutes of Health (award no. UL1 TR000454) (to Dr. Fitzpatrick), and the Atlanta Pediatric Scholars Program grant K12 HD072245 (to Dr. Grunwell). Drs. Grunwell and Fitzpatrick received support for article research from the National Institutes of Health. Mr. Travers has disclosed that he does not have any potential conflicts of interest. For information regarding this article, E-mail: jgrunwe@emory.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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