ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Pulmonology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1625206
This article is part of the Research TopicMethods In Pediatric Infectious Diseases 2024View all 14 articles
Development and Validation of a CD4+/CD8+ Ratio-Based Nomogram to Predict Plastic Bronchitis in Pediatric Mycoplasma pneumoniae Pneumonia
Provisionally accepted
- 1Pulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), China, Fuzhou, China
- 2Department of Laboratory Diagnosis, Fuzhou KingMed for Clinical Laboratory Co., Ltd, Fuzhou, China
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Introduction: Plastic bronchitis (PB) is a rare but severe complication of Mycoplasma pneumoniae pneumonia (MPP) in children. Early identification of PB is critical for timely intervention. This study aimed to develop and validate a nomogram incorporating the CD4+/CD8+ ratio to predict PB risk in children with MPP who underwent bronchoscopy.Methods: This single-center, retrospective cohort study was conducted at Fujian Children's Hospital, China, from January 2023 to December 2024. A total of 281 children hospitalized with MPP, including 39 patients who developed PB, were included. Key predictors for nomogram were selected out of 19 variables using least absolute shrinkage and selection operator regression, followed by multivariable logistic regression. Model performance was evaluated through discrimination, calibration, and decision curve analysis (DCA). Internal validation was performed using the Bootstrap method with 1000 resamples.The nomogram incorporated four independent predictors-fever duration, atelectasis, elevated D-dimer, and reduced CD4+/CD8+ ratio. It demonstrated strong discrimination (AUC = 0.83, 95% CI 0.77-0.90) and calibration (Hosmer-Lemeshow P = 0.303), with superior net benefit across risk thresholds of 0.1-0.7 by decision curve analysis, supporting its clinical utility for early risk stratification. Bootstrap validation confirmed robust performance with minimal overfitting. Discussion: CD4+/CD8+ ratio based nomogram provides a practical tool for predicting PB risk in children with MPP, which may facilitate early bronchoscopy leading to improved patient outcomes.
Keywords: Plastic bronchitis, Mycoplasma pneumoniae, Pneumonia, nomogram, CD4+/CD8+ ratio, Children, LASSO regression, bootstrap validation
Received: 08 May 2025; Accepted: 11 Jul 2025.
Copyright: © 2025 Lian, Lin, Dong, Wei, Huang, Jiang and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Di Lian, Pulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), China, Fuzhou, China
Qiuyu Tang, Pulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), China, Fuzhou, China
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