A causal forest model integrating quantitative CT scores to predict benefit from flexible bronchoscopy in pediatric Mycoplasma pneumoniae pneumonia: a two-center retrospective study

作者：Zhoumeng Ying, Jing Li, Zheming Li, Ge Hu, Fei Yang, Zhu Zhu, Wei Han, Zhenchen Zhu, Baofeng Zhang, Zhen Zhou, Mengyu Duan, Weixiong Tan, Xinxin Li, Zhengyu Jin, Lan Song, Gang Yu · 发表于：Respiratory Research · 年份：2025 · DOI：10.1186/s12931-025-03447-8 · 被引用次数：2 · 研究领域：Pneumonia and Respiratory Infections、Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis、COVID-19 diagnosis using AI

BACKGROUND: Flexible bronchoscopy (FB) is recommended for pediatric Mycoplasma pneumoniae pneumonia (MPP) with persistent consolidation or atelectasis, though substantial heterogeneity in treatment effects exists. This study aimed to develop a causal forest-based predictive model to identify pediatric MPP patients most likely to benefit from FB. METHODS: This retrospective two-center study enrolled pediatric MPP patients in derivation (n = 753) and validation (n = 139) cohorts. Clinical, laboratory, and AI-quantified computed tomography (CT) data were analyzed. Individual treatment effects (ITEs) were estimated using causal forest algorithms. FB-beneficial subgroups were defined using receiver operating characteristic (ROC) analysis of ITEs, with the varying treatment effect across the subgroups validated via multivariable linear regression. Subgroup characteristics, feature importance, and heatmap-based feature interactions were also analyzed. RESULTS: FB treatment significantly reduced total fever duration in identified FB-beneficial subgroups in both derivation (β = - 1.16, p < 0.001) and validation (β = - 0.68, p = 0.04) cohorts. These beneficial subgroups exhibited significantly higher consolidation/atelectasis volume (CAV), pneumonia attenuation (PA), and consolidation-to-pneumonia ratio (CAR) compared to non-beneficial groups (all p < 0.001). Heatmap analyses confirmed that increased CAV combined with elevated PA or lymphocyte counts could improve FB efficacy. CONCLUSI...