Prediction model for risk of multiple organ dysfunction syndrome in wasp sting patients: development and validation

Multiple organ dysfunction syndrome (MODS) is a life-threatening complication of wasp stings. This study aimed to identify factors associated with MODS and develop a quantitative risk prediction model.

A retrospective cohort study included 324 wasp sting patients (January 2018-December 2023), divided into MODS (n = 90) and non-MODS (n = 234) groups. General characteristics, imaging findings, and laboratory parameters were compared. Composite indicators with clinical interpretability were incorporated into binary logistic regression to identify risk factors. A nomogram-based prediction model was established and evaluated using ROC curves, calibration curves, and decision curves.

Significant differences were observed between groups in age, time from sting to admission, pleural effusion, RALE score, PLT, LYM, MO, FIB, ALB, MPV/PLT, P-LCR, FAR, FPR, CLR, SHR, NLR, PLR, PNR, SIRI, and SII (all P < 0.05). After excluding collinear variables (VIF > 5), binary logistic regression identified age, time to admission, pleural effusion, RALE score, MPV/PLT, and SIRI as independent risk factors (OR > 1, all P < 0.05). A nomogram prediction model was developed. ROC analysis showed an AUC of 0.828 (95% CI: 0.776-0.880). At the optimal cutoff of 0.368, sensitivity was 66.7%, specificity 87.9%, PPV 68.9%, and NPV 86.8%. Calibration curves showed good agreement, and decision curves demonstrated high net clinical benefit.

MODS occurrence after wasp stings may be associated with RALE score, MPV/PLT, and SIRI levels, while the roles of age, time to admission, and pleural effusion require further validation. The nomogram model provides a useful reference for clinical MODS risk assessment but lacks external validation, requiring confirmation in future large-scale, multicenter, prospective studies.