Construction and Verification of a Predictive Model for Risk Factors in Children With Severe Adenoviral Pneumonia

Abstract

ObjectiveTo construct and validate a predictive model for risk factors in children with severe adenoviral pneumonia based on chest low-dose CT imaging and clinical features.MethodsA total of 177 patients with adenoviral pneumonia who underwent low-dose CT examination were collected between January 2019 and August 2019. The assessment criteria for severe pneumonia were divided into mild group (N = 125) and severe group (N = 52). All cases divided into training cohort (N = 125) and validation cohort (N = 52). We constructed a prediction model by drawing a nomogram and verified the predictive efficacy of the model through the ROC curve, calibration curve and decision curve analysis.ResultsThe difference was statistically significant (P < 0.05) between the mild adenovirus pneumonia group and the severe adenovirus pneumonia group in gender, age, weight, body temperature, L/N ratio, LDH, ALT, AST, CK-MB, ADV DNA, bronchial inflation sign, emphysema, ground glass sign, bronchial wall thickening, bronchiectasis, pleural effusion, consolidation score, and lobular inflammation score. Multivariate logistic regression analysis showed that gender, LDH value, emphysema, consolidation score, and lobular inflammation score were severe independent risk factors for adenovirus pneumonia in children. Logistic regression was employed to construct clinical model, imaging semantic feature model, and combined model. The AUC values of the training sets of the three models were 0.85 (0.77–0.94), 0.83 (0.75–0.91), and 0.91 (0.85–0.97). The AUC of the validation set was 0.77 (0.64–0.91), 0.83 (0.71–0.94), and 0.85 (0.73–0.96), respectively. The calibration curve fit good of the three models. The clinical decision curve analysis demonstrates the clinical application value of the nomogram prediction model.ConclusionThe prediction model based on chest low-dose CT image characteristics and clinical characteristics has relatively clear predictive value in distinguishing mild adenovirus pneumonia from severe adenovirus pneumonia in children and might provide a new method for early clinical prediction of the outcome of adenovirus pneumonia in children.

Development and validation of a novel nomogram to predict severe adenovirus pneumonia in children with adenovirus pneumonia

“…In our study, the level of L% in children with SAP was signi cantly lower than those in the MAP group. This result was consistent with that of previous studies [22], and it could be explained by immunosuppression in patients with SAP, which resulted in a lower percentage of lymphocytes. A previous study con rmed that when SAP occurs, the number of CD4 + T cells decreases signi cantly, resulting in cellular immunosuppression in the body [23].…”

Factors Associated with Severe Adenovirus Pneumonia in Children: A Retrospective Study from Guangzhou, China (2017-2019)

“…However, contrary to our findings, Zhang et al [ 15 ] and Chen et al [ 8 ] reported a high level of WBC in children with severe adenovirus pneumonia, which can be attributed to the difference of co-infected microorganisms and the statistical bias. In addition, imaging features showed that patients with severe pneumonia had more infiltration and consolidation of lung lobes, which were also consistent with He’s results [ 29 ]. All these differences in clinical features and laboratory findings could provide valuable clues for clinical physicians to differentiate mild adenovirus pneumonia from severe cases.…”

“…Compared to the non-severe group, the severe group presented more serious symptoms, including more common arrhythmia, more ascites, and other intra- and extra-pulmonary symptoms. In terms of laboratory findings, we found that, compared with mild adenovirus pneumonia, the severe group had more prominent laboratory abnormalities comprising decreased ability to respond to inflammation (decreased WBC and increased CRP) and elevated levels of transaminases and muscle enzymes, which indicated an appearance of corresponding target organ severer injuries and were consistent with He’s results [ 29 ]. However, contrary to our findings, Zhang et al [ 15 ] and Chen et al [ 8 ] reported a high level of WBC in children with severe adenovirus pneumonia, which can be attributed to the difference of co-infected microorganisms and the statistical bias.…”

Pediatric adenovirus pneumonia: clinical practice and current treatment

“…Along with the development of pneumonia, imaging may present a larger part of lung lobes involved, which is why it is hard to distinguish adenovirus pneumonia and bacterial pneumonia, resulting in misdiagnosis. Furthermore, CT is more sensitive than X-ray in detecting, locating, and measuring lung lesions where the presence of pulmonary atelectasis and pleural effusions is often indicative of severe cases ( 78 , 79 ).…”