A Multivariable Prediction Model and Bedside Score for Death or Bronchiolitis Obliterans in Pediatric Severe Adenovirus Pneumonia

作者：Wei Hou, Meng Yang, Xueyan Shang, Man Zhang, Wen Geng, Liyuan Tian · 发表于：Discovery Medicine · 年份：2026 · DOI：10.24976/discov.med.202638210.178 · 研究领域：Virus-based gene therapy research、Respiratory viral infections research、Mesenchymal stem cell research

Background: Severe adenovirus pneumonia (SAP) in children is associated with both in-hospital mortality and long-term respiratory sequelae, particularly bronchiolitis obliterans (BO). However, most previous studies have focused on single biomarkers or single clinical endpoints, limiting integrated prognostic assessment. This study aimed to develop and internally validate a multivariable prediction model for a composite adverse outcome of in-hospital death or BO in pediatric SAP.Methods: This single-center, retrospective, patient-level integrated analysis included 90 unique children with SAP after cross-study deduplication and eligibility screening of three partially overlapping source cohorts. The primary outcome was a composite of in-hospital death or BO. Candidate predictors were screened using least absolute shrinkage and selection operator regression with 10-fold cross-validation, followed by multivariable logistic regression and backward elimination based on the Akaike information criterion. Model performance was assessed by discrimination, calibration, decision curve analysis, and bootstrap internal validation. A simplified bedside risk score was subsequently derived from the final model.Results: The composite adverse outcome occurred in 21 of 90 children (23.3%), including 13 in-hospital deaths and 8 cases of BO. Five predictors were retained in the final model: an increase in the neutrophil-to-lymphocyte ratio from baseline to the treatment-intensive phase (p = 0.001)...