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Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma
Di Lian1, Chenye Lin1, Xiangmei Dong2
1Pulmonology Department, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.
Insights
This study developed a nomogram using CD4+/CD8+ ratio to predict plastic bronchitis (PB) in children with Mycoplasma pneumoniae pneumonia (MPP). The tool aids early identification and intervention for this rare but severe complication.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Medical Diagnostics
Background:
- Plastic bronchitis (PB) is a rare, severe complication of Mycoplasma pneumoniae pneumonia (MPP) in children.
- Early identification of PB is crucial for effective treatment and improved patient outcomes.
Purpose of the Study:
- To develop and validate a predictive nomogram for plastic bronchitis (PB) risk in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP).
- To incorporate the CD4+/CD8+ ratio as a key predictor in the nomogram for enhanced risk stratification.
Main Methods:
- A retrospective cohort study including 281 children with MPP, with 39 developing PB.
- Utilized least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression to identify predictors.
- Assessed model performance using discrimination, calibration, and decision curve analysis, with internal validation via Bootstrap resampling.
Main Results:
- A nomogram was developed incorporating fever duration, atelectasis, elevated D-dimer, and reduced CD4+/CD8+ ratio.
- The nomogram demonstrated strong predictive performance (AUC = 0.83) and good calibration.
- Decision curve analysis indicated significant clinical utility for early risk stratification.
Conclusions:
- The CD4+/CD8+ ratio-based nomogram is a practical tool for predicting PB risk in children with MPP.
- This nomogram can facilitate timely bronchoscopy, potentially leading to improved patient outcomes.
Introduction:
Plastic bronchitis (PB) is a rare but severe complication of Mycoplasma pneumoniae pneumonia (MPP) in children. Early identification of PB is critical for timely intervention. This study aimed to develop and validate a nomogram incorporating the CD4+/CD8 + ratio to predict PB risk in children with MPP who underwent bronchoscopy.
Methods:
This single-center, retrospective cohort study was conducted at Fujian Children's Hospital, China, from January 2023 to December 2024. A total of 281 children hospitalized with MPP, including 39 patients who developed PB, were included. Key predictors for nomogram were selected out of 19 variables using least absolute shrinkage and selection operator regression, followed by multivariable logistic regression. Model performance was evaluated through discrimination, calibration, and decision curve analysis (DCA). Internal validation was performed using the Bootstrap method with 1,000 resamples.
Results:
The nomogram incorporated four independent predictors-fever duration, atelectasis, elevated D-dimer, and reduced CD4+/CD8 + ratio. It demonstrated strong discrimination (AUC = 0.83, 95% CI 0.77-0.90) and calibration (Hosmer-Lemeshow P = 0.303), with superior net benefit across risk thresholds of 0.1-0.7 by decision curve analysis, supporting its clinical utility for early risk stratification. Bootstrap validation confirmed robust performance with minimal overfitting.
Discussion:
CD4+/CD8 + ratio based nomogram provides a practical tool for predicting PB risk in children with MPP, which may facilitate early bronchoscopy leading to improved patient outcomes.
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