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Risk factors and prediction models for bronchiolitis obliterans after severe adenoviral pneumonia

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Abstract

Severe adenoviral pneumonia (SAP) can cause post-infectious bronchiolitis obliterans (PIBO) in children. We aimed to investigate the relevant risk factors for PIBO and develop a predictive nomogram for PIBO in children with SAP. This prospective study analysed the clinical data of hospitalised children with SAP and categorised them into the PIBO and non-PIBO groups. Least absolute shrinkage and selection operator (LASSO) regressions were applied to variables that exhibited significant intergroup differences. Logistic regression was adopted to analyse the risk factors for PIBO. Additionally, a nomogram was constructed, and its effectiveness was assessed using calibration curves, C-index, and decision curve analysis. A total of 148 hospitalised children with SAP were collected in this study. Among them, 112 achieved favourable recovery, whereas 36 developed PIBO. Multivariable regression after variable selection via LASSO revealed that aged < 1 year (OR, 2.38, 95% CI, 0.82–6.77), admission to PICU (OR, 24.40, 95% CI, 7.16–105.00), long duration of fever (OR, 1.16, 95% CI, 1.04–1.31), and bilateral lung infection (OR, 8.78, 95% CI, 1.32–195.00) were major risk factors for PIBO. The nomogram model included the four risk factors: The C-index of the model was 0.85 (95% CI, 0.71–0.99), and the area under the curve was 0.85 (95% CI, 0.78–0.92). The model showed good calibration with the Hosmer-Lemeshow test (χ2 = 8.52, P = 0.38) and was useful in clinical settings with decision curve analysis.

Conclusion: Age < 1 year, PICU admission, long fever duration, and bilateral lung infection are independent risk factors for PIBO in children with SAP. The nomogram model may aid clinicians in the early diagnosis and intervention of PIBO.

What is Known:

• Adenoviruses are the most common pathogens associated with PIBO.

• Wheezing, tachypnoea, hypoxemia, and mechanical ventilation are the risk factors for PIBO.

What is New:

• Age < 1 year, admission to PICU, long duration of fever days, and bilateral lung infection are independent risk factors for PIBO in children with SAP.

• A prediction model presented as a nomogram may help clinicians in the early diagnosis and intervention of PIBO.

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Availability of data and material

All data generated or analysed during this study are included in this article.

Abbreviations

ALT:

Alanine aminotransferase

CI:

Confidence interval

HAdVs:

Human adenovirus

IVIG:

Intravenous immunoglobulin

LASSO:

Least absolute shrinkage and selection operator

LDH:

Lactate dehydrogenase

OR:

Odds ratio

PaCO2 :

Partial pressure of carbon dioxide

PIBO:

Post-infectious bronchiolitis obliterans

PICU:

Paediatric intensive care units

SAP:

Severe adenoviral pneumonia

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Acknowledgements

All the authors thank all participants in the study for their unstinted cooperation.

Funding

The authors gratefully acknowledge the financial support from the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (Grant number 2021KY213), as well as the Basic Scientific Research Project of Wenzhou Science and Technology Bureau (Grant number Y20210001).

Author information

Author notes

  1. Shunhang Wen and Ming Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Children’s Respiration Disease, the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People’s Republic of China

    Shunhang Wen, Ming Xu, Weigang Jin, Luyao Zeng, Gang Yu, Fangfang Lv, Lili Zhu, Changfu Xu, Yangming Zheng, Lin Dong, Li Lin & Hailin Zhang

  2. Department of Pediatrics, Jinhua Maternal and Child Health Care Hospital, Jinhua, 321000, Zhejiang, People’s Republic of China

    Zupan Lin

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  1. Shunhang Wen
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Contributions

Wen SH and Zhang HL contributed to the study design and interpreted the results. Jin WG, Zeng LY and Lin ZP collected the clinical data. Lv FF, Zhu LL collected respiratory specimens. Xu CF and Xu M analysed data. Zheng YM, Lin L and Dong L clinical followed-up. Wen SH and Xu M wrote the manuscript. Zhang HL provided critical suggestions on the results and contributed to revision of the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Hailin Zhang.

Ethics declarations

Ethics approval

The study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Ethics Committee of the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University (Approval Number No. LCKY2020-250).

Consent to participate

Participants received detailed information about the project and voluntarily agreed to participate. All participants gave their written consent to participate.

Competing interests

The authors declare no competing interests.

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Communicated by Peter de Winter

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Wen, S., Xu, M., Jin, W. et al. Risk factors and prediction models for bronchiolitis obliterans after severe adenoviral pneumonia. Eur J Pediatr 183, 1315–1323 (2024). https://doi.org/10.1007/s00431-023-05379-1

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