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A routine blood parameter-based nomogram to predict prolonged fever in children with primary EBV infection
Ying Ding1, Chunyu Lu1, Kun Wang1
1Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China.
Insights
A new clinical nomogram can identify children at high risk for prolonged fever from Epstein-Barr virus (EBV) infection using routine blood tests. This tool aids in early risk stratification for better patient management.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Acute primary Epstein-Barr virus (EBV) infection commonly causes fever in children.
- Prolonged fever (>1 week) occurs in a significant subset of these children, necessitating careful management.
- Identifying children at risk for prolonged fever early is crucial for timely intervention.
Purpose of the Study:
- To develop and validate a clinical nomogram for predicting prolonged fever in children with acute primary EBV infection.
- To utilize routine blood parameters for accessible and early risk assessment.
Main Methods:
- Retrospective analysis of 791 hospitalized children with primary EBV infection.
- Screening of routine blood parameters using univariate analysis and LASSO regression for variable selection.
- Construction and validation of a multivariate logistic regression model visualized as a nomogram, assessed by AUC, calibration plots, and DCA.
Main Results:
- Prolonged fever was observed in 27.4% of the cohort, with higher antiviral therapy rates.
- White blood cell count (WBC), neutrophil count (NEU), platelet count (PLT), and atypical lymphocyte proportion (AL) were identified as key predictors.
- The nomogram demonstrated good predictive performance with an AUC of 0.728.
Conclusions:
- A nomogram incorporating WBC, NEU, PLT, and AL offers a practical tool for early risk stratification of prolonged EBV-related fever in children.
- This model serves as a valuable initial reference for clinical decision-making.
- Further validation through multicenter prospective studies is recommended to confirm its clinical utility.
Objective:
This study aimed to develop a clinical nomogram using routine blood parameters to identify the risk of prolonged fever (>1 week) in children with acute primary Epstein-Barr virus (EBV) infection.
Methods:
This retrospective study involved 791 hospitalized children with primary EBV infection. Patients were divided into two groups: fever duration ≤1 week and >1 week. Candidate routine blood parameters were screened through univariate analysis. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for variable selection to mitigate overfitting. A multivariate logistic regression model was then constructed using the optimal predictors and visualized as a nomogram. Model performance was rigorously quantified through the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA), with internal validation performed using 1,000 bootstrap resamples.
Results:
Prolonged fever affected 27.4% of the cohort, and antiviral therapy was administered to all these patients (100%), significantly higher than the 56.1% in the short fever group (P < 0.001). LASSO regression identified white blood cell count (WBC), neutrophil count (NEU), platelet count (PLT), and atypical lymphocyte proportion (AL) as optimal predictors. The nomogram including these four parameters predicted prolonged fever with an AUC of 0.728 (95% CI: 0.689-0.768). Calibration and DCA confirmed the nomogram's clinical utility.
Conclusion:
A nomogram based on four routine blood parameters (WBC, NEU, PLT and AL) provides a practical method for the early risk stratification of children at high risk for prolonged EBV-related fever. This model serves as an initial reference, though its clinical value requires validation through multicenter prospective studies.
