ArticleFrontiers in pediatrics2026
Development and internal validation of a multidimensional nomogram integrating PIV, LDH, and FeNO for predicting poor asthma control in school-aged children.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Poor asthma control remains common in school-aged children despite guideline-based treatment. Traditional assessment tools have limitations, highlighting the need for objective and multidimensional biomarkers. This study aimed to develop and internally validate a risk stratification model integrating systemic inflammatory, metabolic, and airway-specific indicators for identifying uncontrolled asthma. Methods: In this retrospective study, 232 children with bronchial asthma (aged 6-14 years) were enrolled. Asthma control was assessed using the Childhood Asthma Control Test (C-ACT). Clinical data, laboratory biomarkers, and pulmonary function parameters were collected. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection, followed by multivariate logistic regression to identify independent predictors. A nomogram was constructed, and internal model performance was evaluated using receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA). Results: Six variables were identified as independent predictors of poor asthma control: PIV, LDH, FeNO, Vitamin D, asthma duration, and FEV1% predicted. PIV (OR=1.008), LDH (OR=1.043), FeNO (OR=1.056), and asthma duration (OR=1.251) were risk factors, whereas Vitamin D (OR=0.891) and FEV1% predicted (OR=0.953) were protective. The combined model demonstrated superior predictive performance (AUC = 0.886, 95% CI: 0.835-0.937) compared with individual biomarkers and the baseline model. The nomogram showed good calibration and provided favorable clinical net benefit in DCA. Conclusions: A multidimensional model integrating PIV, LDH, FeNO, Vitamin D, asthma duration, and lung function provides accurate and clinically applicable risk stratification of poor asthma control in school-aged children. This approach may facilitate localized risk assessment and support personalized management in pediatric asthma.
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