# Nomogram for prediction of plastic bronchitis in Chinese children with pneumonia

## TL;DR

This study created a tool to predict plastic bronchitis in children with pneumonia based on risk factors like mycoplasma infection and high fever.

## Contribution

A novel nomogram was developed to predict plastic bronchitis in children with pneumonia using clinical risk factors.

## Key findings

- Mycoplasma infection, atelectasis, high fever, elevated neutrophils, and lactate dehydrogenase are risk factors for plastic bronchitis.
- The nomogram achieved an area under the ROC curve of 0.857, indicating strong predictive accuracy.
- Calibration and decision curve analysis confirmed the nomogram's clinical usefulness for early detection of plastic bronchitis.

## Abstract

This study investigated risk factors for plastic bronchitis (PB) in children with pneumonia and created a nomogram for early detection.

We retrospectively analyzed data from 487 children with pneumonia who underwent bronchoscopic alveolar lavage between 2018 and 2024. Children were divided into a PB group (n = 65) and a No-PB group (n = 422). Key indicators were identified using regression analysis, and a nomogram prediction model was developed. Its effectiveness was evaluated using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and the bootstrap (BS) method.

A total of 65 patients (13.3%) out of 487 had PB. Multivariate logistic regression analysis indicated that mycoplasma infection, atelectasis, high fever peak, high neutrophil levels and elevated lactate dehydrogenase levels were risk factors for PB development. Additionally, the BS-ROC curve of the developed nomogram had an area under the curve value of 0.857 (95% confidence interval: 0.808–0.905). The calibration curve analysis revealed a strong agreement between the actual and predicted probabilities of PB development, and DCA highlighted the clinical relevance of the nomogram.

A nomogram for MP infection, fever peak, LDH, maximum neutrophils percentage (N%max), and atelectasis was established to predict the risk of PB in children with pneumonia. The nomogram effectively identifies PB early, and bronchoscopy is advised for high-risk children. However, the nomogram needs external validation before practical use.