Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumonia
IntroductionPlastic 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 chi...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1625206/full |
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| author | Di Lian Chenye Lin Xiangmei Dong Jianxing Wei Xueling Huang Hongman Jiang Qiuyu Tang |
| author_facet | Di Lian Chenye Lin Xiangmei Dong Jianxing Wei Xueling Huang Hongman Jiang Qiuyu Tang |
| author_sort | Di Lian |
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| description | IntroductionPlastic 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.MethodsThis 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 1,000 resamples.ResultsThe 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.DiscussionCD4+/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. |
| format | Article |
| id | doaj-art-e57f1663d6f74cc28f7cd2ba141db79a |
| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-e57f1663d6f74cc28f7cd2ba141db79a2025-08-20T03:58:41ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-07-011310.3389/fped.2025.16252061625206Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumoniaDi Lian0Chenye Lin1Xiangmei Dong2Jianxing Wei3Xueling Huang4Hongman Jiang5Qiuyu Tang6Pulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, ChinaPulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, ChinaFuzhou KingMed for Clinical Laboratory Co., Ltd, Department of Laboratory Diagnosis, Fuzhou, Fujian, ChinaPulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, ChinaPulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, ChinaPulmonology Department, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, ChinaCollege of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, ChinaIntroductionPlastic 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.MethodsThis 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 1,000 resamples.ResultsThe 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.DiscussionCD4+/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.https://www.frontiersin.org/articles/10.3389/fped.2025.1625206/fullplastic bronchitisMycoplasma pneumoniaepneumonianomogramCD4+/CD8+ ratiochildren |
| spellingShingle | Di Lian Chenye Lin Xiangmei Dong Jianxing Wei Xueling Huang Hongman Jiang Qiuyu Tang Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumonia Frontiers in Pediatrics plastic bronchitis Mycoplasma pneumoniae pneumonia nomogram CD4+/CD8+ ratio children |
| title | Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumonia |
| title_full | Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumonia |
| title_fullStr | Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumonia |
| title_full_unstemmed | Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumonia |
| title_short | Development and validation of a CD4+/CD8+ ratio-based nomogram to predict plastic bronchitis in pediatric Mycoplasma pneumoniae pneumonia |
| title_sort | development and validation of a cd4 cd8 ratio based nomogram to predict plastic bronchitis in pediatric mycoplasma pneumoniae pneumonia |
| topic | plastic bronchitis Mycoplasma pneumoniae pneumonia nomogram CD4+/CD8+ ratio children |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1625206/full |
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