Analysis of Risk Factors and Development of a Predictive Nomogram for Bronchiolitis Obliterans in Children With Severe Adenovirus Pneumonia: A Retrospective Study.

BACKGROUND

Bronchiolitis obliterans (BO) is a rare chronic pulmonary condition in pediatric patients, characterized by irreversible fibrotic constriction of the small airways. This study aims to analyze the risk factors for BO caused by severe adenovirus pneumonia (SAP) and to develop a nomogram model for personalized prediction.

METHODS

We retrospectively analyzed 251 children with SAP admitted to the Children's Hospital of Nanjing Medical University between January 2017 and March 2024. Among them, 77 were classified into the BO group and 174 into the non-BO group. A predictive nomogram was developed based on independent risk factors identified through univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression.

RESULTS

Multivariable analysis identified the following independent risk factors for BO: wheezing (odds ratio [OR] = 4.78; 95% confidence interval [CI], (2.00∼11.40); p < 0.001), large lobar consolidation (OR = 8.53; 95% CI, 3.63∼20.02; p < 0.001), length of hospital stay (OR = 1.20; 95% CI, 1.08-1.33; p < 0.001), and duration of fever (OR = 1.20; 95% CI, 1.09-1.32; p < 0.001). Mechanical ventilation showed a trend toward increased risk but did not reach statistical significance (OR = 5.35; 95% CI, 0.74-38.56; p = 0.096). The nomogram demonstrated excellent discriminative ability, with an area under the curve of 0.90 (95% CI: 0.85-0.94). Calibration curves indicated good agreement between predicted and observed outcomes. Decision curve analysis showed a net clinical benefit within a clinically relevant threshold probability range of 0.10-0.70.

CONCLUSIONS

A nomogram incorporating five independent risk factors-wheezing, duration of fever, length of hospital stay, mechanical ventilation, and large lobar consolidation-was developed to predict BO risk in children with SAP.