Should morbidity replace mortality as an endpoint for clinical trials in intensive care?

Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices

“…Therefore, is it not time to reconsider disease-specific stratification criteria in any future treatment evaluation, even though this will inevitably mean that studies will take much longer to recruit sufficient patients. Finally, since death in a previously normal child is now an infrequent end point in AHRF, our data reiterates a previously discussed idea [18], that other markers sought.…”

Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children

“…These data support the concept that the PELOD score and its progression in the PICU can be an outcome measure of interest. Measurement of organ dysfunction with scores such as the PELOD can be useful both for administrative PICU management [29][30][31] and as a secondary outcome measure of studies conducted in the ICU, 12,32 particularly the PICU, 21,33 where the death rate is low. Two recent examples can be given.…”

“…[8][9][10] These scores quantify organ dysfunction precisely and can be used as indicators of the severity of illness throughout the clinical course. They can also be used as baseline and outcome measures in clinical studies conducted in ICUs 11,12 and pediatric ICUs (PICUs). 13 The PELOD score calculated with data collected over the entire PICU stay has been validated (using the most abnormal value of each variable during the entire PICU stay).…”

The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study

“…Recently authors have questioned the adequacy of all cause mortality as an end point [16]. A meaningful end point can only be chosen when a direct relation between an event and its consequences is known.…”