The pediatric critical care community has suddenly and unexpectedly lost one of its pillars. Dr. Hector Raul Wong died on Sunday, January 23, 2022, at 58 years of age. Born in Havana, Cuba, in 1963, Hector and his family moved to Miami when he was five years old after the Communist Revolution in that country. After completing his undergraduate studies in biology at Bucknell University in 1985 and his Doctor of Medicine at the University of Medicine and Dentistry of New Jersey in 1989, he trained in pediatrics at Children’s National Medical Center and in critical care medicine and clinical research at Children’s Hospital of Pittsburgh. Upon his appointment as Assistant Professor of Pediatrics at Cincinnati Children’s Hospital in 1995, he advanced quickly and became division director in 1998 and a tenured professor in 2005. In March 2020, he became Interim Chair of the Department of Pediatrics and Interim Director of the Cincinnati Children’s Research Foundation, guiding Cincinnati Children’s Hospital and the Research Foundation through the COVID-19 pandemic until a permanent chair and director were appointed in November 2020, after which time he served as Vice Chair.
Hector was passionate about improving the care of critically ill patients and promoting excellence and equity in the PICU and beyond. He authored over 200 manuscripts, largely focused on pediatric critical illness, and served as both Senior Associate Editor and Senior Editor of Pediatric Critical Care Medicine. He was a driving force behind the 2020 Surviving Sepsis Guidelines (1) and a stalwart of NIH study sections and special emphasis panels. A fellow of the American College of Critical Care Medicine, recipient of multiple Presidential Citations from the Society of Critical Care Medicine, and consistently selected as one of the “Best Doctors in America,” Hector was a physician to be emulated. In him, junior faculty, trainees, patients, nurses, and families found patience, compassion, an impeccable bedside manner, and the healthy skepticism that is so foundational to clinical excellence in the PICU. As Interim Chair, he missed working in the PICU and eagerly returned to clinical care when he became Vice Chair in November 2020. In his various leadership roles, Dr. Wong served as a tireless advocate for the advancement of women and minorities. As Jamilah Hackworth, the associate director for Academic Affairs and Career Development at Cincinnati Children’s Hospital recounted, “He regularly attended Black Faculty and Staff Alliance (BFSA) meetings and always made himself available to discuss and help resolve any challenge that underrepresented minority faculty members may have been experiencing.” As Interim Chair and Vice Chair, he invested in programs and structures aimed at addressing the inequities and disparities at the faculty, fellow, resident, staff, patient, and community levels and served as a role model of inclusivity.
Hector was the consummate clinician scientist. Rarely does adult medicine follow pediatric medicine’s lead, but the adult sepsis community followed his lead for over twenty years. Twenty thousand citations from his nearly 250 peer-reviewed manuscripts, 27 completed and 10 active grants, and over 200 invited national and international lectures are a small testament to his impact on critical care medicine. He was a pioneer in using whole genome expression profiling in complex diseases like pediatric sepsis to identify biologically relevant subtypes (2). His genomics work in pediatric sepsis identified a subgroup of pediatric sepsis patients, for which corticosteroid administration might be harmful (3), and these findings served as a basis for a large, randomized clinical trial on the use of hydrocortisone in pediatric septic shock (4). Recognizing the need for rapid, point-of-care diagnostics for sepsis subgroup stratification, he developed the PERSEVERE-II biomarker panel (5,6), which is in the process of commercialization. His work has served to develop risk stratification strategies in sepsis-associated acute kidney injury (7), myocardial dysfunction (8), and acute respiratory distress syndrome (9,10). He was adept at moving from bedside to bench, leveraging his findings in sepsis genomic data to elucidate the role of matrix metalloproteinase-8 (11,12), olfactomedin-4 (13), and interleukin-27 (14), among others in sepsis pathophysiology.
While his work at the molecular, tissue, organ, and patient levels is impressive, Hector’s most lasting impacts on pediatric critical care medicine are his trainees and mentees. A tireless advocate for the young physician scientist, he expended tremendous time and effort supporting, protecting, and encouraging the next generation of pediatric critical care physician-scientists. I remember when he stood behind me as I found out that I received a fundable score on my first R01, and his excitement dwarfed mine. He created an ideal environment for the development of trainees and consistently placed his fellows in the most coveted academic positions around the globe. A recent graduate from critical care medicine fellowship was interviewing for a faculty position to continue his work in pediatric sepsis. While interviewing at a top-rated program, the department head commented, “You want to work in pediatric critical care and study sepsis? You would be a fool to go anywhere but Cincinnati to work with Hector Wong.” During his tenure, Hector mentored dozens of trainees, including more than 32 current pediatric intensivist physician-scientists who carry on his inspirational desire to improve the care for critically ill patients. These mentees are academic leaders serving as division directors, department chair, chief operating officer, and in other leadership positions.
Hector had a knack for knowing the important question and being able to sift through the data to find the key result. His endless curiosity and creativity allowed him to ask the insightful question, framed in an unintimidating way, or have the key suggestion that would help the basic, translational, or clinical researcher become “unstuck.” He had the uncommon trait of being simultaneously critical and optimistic. Above the light switch in his office, he had a placard that read:
no matter where you read it
or who has said it, not even if
I have said it, unless it agrees
with your own reason and
your own common sense.
Hector recognized superfluity, unsupported conjecture, and unfounded bias as cognitive anchors from which we must be freed. His insistence on freeing his trainees, mentees, and collaborators from these anchors fostered personal and intellectual growth that was not always comfortable but was always necessary. It was this “tough love” approach that endeared him to many in our community.
Although he was passionate about his work, Hector found much of his life’s meaning away from the hospital. His favorite days were spent fly fishing for trout in streams around the United States and Canada and working on his house and property in the North Carolina mountains. He loved coaching his stepson’s baseball team, and he nearly lost vision in his right eye from a solid line drive. He loved to play the game and was a “sneaky strong” wiry left-handed second baseman. Whether working or relaxing, Hector epitomized the concept of carpe diem and made the most of every moment.
Baseball, in particular, was an analogy deeply woven into Hector’s life. In reflecting on Hector’s life, his early life mentor Jeffrey Whitsett wrote:
Hector brought his team spirit from the ballpark--keep your eyes on the ball, hang tight in the batter’s box in spite of fast pitches, hold fast to your bat, loosen up in the dugout, listen to your coach and teammates, respect the opposing team and play ball!
We in the pediatric critical care community are all on the same team, and we have lost one of our captains. Now, we must regroup, celebrate his life, and continue in his stead.
Hector is survived by his parents Raul and Mercedes, his wife Sue, and his children Caroline, Madeline, Eleanor, and Max.
1. Weiss SL, Peters MJ, Alhazzani W, et al.: Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020; 21:e52–e106
2. Wong HR, Cvijanovich NZ, Allen GL, et al.: Validation of a gene expression-based subclassification strategy for pediatric septic shock. Crit Care Med. 2011; 39:2511–2517
3. Wong HR, Cvijanovich NZ, Allen GL, et al.: Corticosteroids are associated with repression of adaptive immunity gene programs in pediatric septic shock. Am J Respir Crit Care Med. 2014; 189:940–946
4. Menon K, McNally D, O’Hearn K, et al.: A randomized controlled trial of corticosteroids in pediatric septic shock: A pilot feasibility study*. Pediatr Crit Care Med. 2017; 18:505–512
5. Wong HR, Cvijanovich NZ, Anas N, et al.: Pediatric sepsis
biomarker risk model-II: Redefining the pediatric sepsis
biomarker risk model with septic shock phenotype. Crit Care Med. 2016; 44:2010–2017
6. Wong HR, Caldwell JT, Cvijanovich NZ, et al.: Prospective clinical testing and experimental validation of the Pediatric Sepsis
Biomarker Risk Model. Sci Transl Med. 2019; 11:eaax9000
7. Stanski NL, Stenson EK, Cvijanovich NZ, et al.: PERSEVERE biomarkers predict severe acute kidney injury and renal recovery in pediatric septic shock. Am J Respir Crit Care Med. 2020; 201:848–855
8. Lautz AJ, Wong HR, Ryan TD, et al.: Pediatric sepsis
biomarker risk model biomarkers and estimation of myocardial dysfunction in pediatric septic shock. Pediatr Crit Care Med. 2021; 23:e20–e28
9. Yehya N, Wong HR: Adaptation of a biomarker-based sepsis mortality risk stratification tool for pediatric acute respiratory distress syndrome. Crit Care Med. 2017; 46:e9–e16
10. Gardner MM, Kirschen MP, Wong HR, et al.: Biomarkers associated with mortality in pediatric patients with cardiac arrest and acute respiratory distress syndrome. Resuscitation. 2022; 170:184–193
11. Ganatra HA, Varisco BM, Harmon K, et al.: Zinc supplementation leads to immune modulation and improved survival in a juvenile model of murine sepsis. Innate Immun. 2017; 23:67–76
12. Daly MC, Atkinson SJ, Varisco BM, et al.: Role of matrix metalloproteinase-8 as a mediator of injury in intestinal ischemia and reperfusion. FASEB J. 2016; 30:3453–3460
13. Alder MN, Opoka AM, Lahni P, et al.: Olfactomedin-4 is a candidate marker for a pathogenic neutrophil subset in septic shock. Crit Care Med. 2017; 45:e426–e432
14. Hanna WJ, Berrens Z, Langner T, et al.: Interleukin-27: A novel biomarker in predicting bacterial infection among the critically ill. Crit Care. 2015; 19:378