ArticleTranslational pediatrics2026
Risk factors for plastic bronchitis complicating severe
Article in Translational 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: Plastic bronchitis (PB) is a rare but life-threatening complication of severe Methods: This retrospective cohort study included 166 children (aged 1-14 years) with SMPP admitted between January 2022 and December 2024. Patients were classified into PB (n=51) and non-PB (n=115) groups based on bronchoscopy and randomly split into training and validation sets (7:3 ratio). Eight machine learning algorithms were developed and evaluated based on the area under the receiver operating characteristic curve (AUC), precision-recall curve (PRC), decision curve analysis (DCA), accuracy, and F1-score. The optimal model was selected and interpreted using SHapley Additive exPlanations (SHAP). Candidate risk factors were identified and further analyzed using multivariable logistic regression to develop a nomogram. The predictive model was assessed using both sets and further validated by bootstrap resampling. Results: Generalized linear model (GLM) achieved the highest performance [AUC: 0.951, cross-validation AUC: 0.915, accuracy 0.880, F1-score: 0.825, area under the precision-recall curve (AUPRC): 0.856] in the training set, representing the optimal model. Fever duration, serum prealbumin, and D-dimer were the most influential features in SHAP analysis. Multivariable analysis confirmed these as independent risk factors: fever duration [odds ratio (OR): 1.550, 95% confidence interval (CI): 1.297-1.908, P<0.001], prealbumin (OR: 0.959, 95% CI: 0.939-0.976, P<0.001), and D-dimer (OR: 1.723, 95% CI: 1.157-2.627, P=0.009). The nomogram exhibited acceptable discriminative ability [C-index: 0.933 (95% CI: 0.887-0.980) in the training set; 0.831 (95% CI: 0.717-0.946) in the validation set; 0.913 (95% CI: 0.869-0.957) in bootstrap validation] and calibration (Brier score: 0.106, 0.142, and 0.103, respectively). The Hosmer-Lemeshow goodness-of-fit test yielded χ Conclusions: Fever duration, serum prealbumin, and D-dimer are independent risk factors for PB in children with SMPP. This internally derived nomogram achieved moderate discrimination and acceptable calibration in our limited single-center cohort. Further external validation in independent patient cohorts is therefore necessary to verify its generalizability and clinical utility.
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