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已发表论文
儿童重症腺病毒肺炎闭塞性细支气管炎预测列线图的建立与验证：关键危险因素的识别
Authors Xiao J, Zhang L, Su L, Ali K , Wu S, Zhao M
Received 5 May 2025
Accepted for publication 10 September 2025
Published 16 September 2025 Volume 2025:16 Pages 267—277
DOI https://doi.org/10.2147/PHMT.S533387
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Laurens Holmes, Jr
Jiying Xiao,1 Li Zhang,1 Lin Su,2 Kamran Ali,3 Suling Wu,1 Min Zhao4
1Department of Pulmonology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China; 2Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China; 3Department of Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, 322000, People’s Republic of China; 4Department of Clinical Laboratory, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China
Correspondence: Min Zhao, Department of Clinical Laboratory, Hangzhou Children’s Hospital, No. 195 Wenhui Road, Gongshu District, Hangzhou, Zhejiang, 310015, People’s Republic of China, Email cindyzm@163.com
Objective: This study aimed to identify the risk factors for bronchiolitis obliterans (BO) development in children with severe adenovirus pneumonia (SAP) and to construct and validate a nomogram prediction model.
Methods: This retrospective study included 152 pediatric patients with SAP between January 2019 and December 2023. We categorized these patients as having developed BO (n=36) and non-BO (n=116) based on long-term follow-up outcomes. Key clinical features were optimized using the least absolute shrinkage and selection operator (LASSO) regression and a nomogram was developed using logistic regression. Model performance was assessed and validated through receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis (DCA).
Results: The LASSO regression analysis initially identified nine potential clinical predictors. Subsequent univariable and multivariable logistic regression revealed four independent risk factors significantly associated with BO development, namely, younger age, Odds ratio (OR) =0.94, 95% CI, 0.90– 0.99, p=0.010; longer duration of fever, OR=2.27, 95% CI, 1.52– 3.39, p< 0.001; requirement for tracheoscopy, OR=5.25, 95% CI, 1.06– 26.09, p=0.040; and extended oxygen therapy, OR=1.64, 95% CI, 1.10– 2.43, p=0.010. The final prediction model incorporated three key predictors (months of age, fever duration, and oxygen therapy duration) into a clinically practical nomogram. The model demonstrated excellent discrimination, with an area under the curve (AUC) of 0.95, 95% CI, 0.91– 0.98, a sensitivity of 0.83, and a specificity of 0.93. The Hosmer-Lemeshow test, χ 2=5.24, p=0.732 indicated good calibration, and the DCA demonstrated positive clinical benefits.
Conclusion: We developed and validated a clinically practical nomogram, incorporating three key predictors mainly, months of age, fever duration, and oxygen therapy duration in predicting BO in children with SAP.The model demonstrates strong discriminatory power, reliable calibration, and clinical utility. This tool enables early risk stratification, facilitating timely intervention for high-risk pediatric SAP patients.
Keywords: severe adenovirus pneumonia, bronchiolitis obliterans, risk factors, nomogram, children
1Department of Pulmonology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China; 2Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China; 3Department of Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, 322000, People’s Republic of China; 4Department of Clinical Laboratory, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China
Correspondence: Min Zhao, Department of Clinical Laboratory, Hangzhou Children’s Hospital, No. 195 Wenhui Road, Gongshu District, Hangzhou, Zhejiang, 310015, People’s Republic of China, Email cindyzm@163.com
Objective: This study aimed to identify the risk factors for bronchiolitis obliterans (BO) development in children with severe adenovirus pneumonia (SAP) and to construct and validate a nomogram prediction model.
Methods: This retrospective study included 152 pediatric patients with SAP between January 2019 and December 2023. We categorized these patients as having developed BO (n=36) and non-BO (n=116) based on long-term follow-up outcomes. Key clinical features were optimized using the least absolute shrinkage and selection operator (LASSO) regression and a nomogram was developed using logistic regression. Model performance was assessed and validated through receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis (DCA).
Results: The LASSO regression analysis initially identified nine potential clinical predictors. Subsequent univariable and multivariable logistic regression revealed four independent risk factors significantly associated with BO development, namely, younger age, Odds ratio (OR) =0.94, 95% CI, 0.90– 0.99, p=0.010; longer duration of fever, OR=2.27, 95% CI, 1.52– 3.39, p< 0.001; requirement for tracheoscopy, OR=5.25, 95% CI, 1.06– 26.09, p=0.040; and extended oxygen therapy, OR=1.64, 95% CI, 1.10– 2.43, p=0.010. The final prediction model incorporated three key predictors (months of age, fever duration, and oxygen therapy duration) into a clinically practical nomogram. The model demonstrated excellent discrimination, with an area under the curve (AUC) of 0.95, 95% CI, 0.91– 0.98, a sensitivity of 0.83, and a specificity of 0.93. The Hosmer-Lemeshow test, χ 2=5.24, p=0.732 indicated good calibration, and the DCA demonstrated positive clinical benefits.
Conclusion: We developed and validated a clinically practical nomogram, incorporating three key predictors mainly, months of age, fever duration, and oxygen therapy duration in predicting BO in children with SAP.The model demonstrates strong discriminatory power, reliable calibration, and clinical utility. This tool enables early risk stratification, facilitating timely intervention for high-risk pediatric SAP patients.
Keywords: severe adenovirus pneumonia, bronchiolitis obliterans, risk factors, nomogram, children