Assessment of predictive efficacy for prognosis of pediatric severe

Background: Severe Methods: This secondary analysis used a publicly available, de-identified dataset containing 153 children with SMPP, of whom 39 had PCIS <80 three months after discharge. Distribution-appropriate comparative methods were used. Derived platelet ratios were excluded from primary model development to avoid redundancy with their component variables. A parsimonious logistic model incorporated lobar pneumonia, lung consolidation, and platelet count (PLT); PLT was modeled using a 3-knot restricted cubic spline because of evidence of nonlinearity. Internal validation used 1,000 bootstrap resamples. Discrimination, calibration, Brier score, and decision-curve analysis were evaluated. Results: Lobar pneumonia and lung consolidation were more frequent and PLTs were lower among children with PCIS <80. PLT showed a significant nonlinear association with the outcome. The model had an apparent area under the receiver operating characteristic curve (AUC) of 0.890 [95% bootstrap confidence interval (CI): 0.832-0.940] and an optimism-corrected AUC of 0.877. The apparent and optimism-corrected Brier scores were 0.117 and 0.129, respectively; the optimism-corrected calibration intercept was -0.041 and the calibration slope was 0.890. Conclusions: Early HRCT abnormalities and PLT provided complementary information regarding a 3-month PCIS-defined physiological outcome in this severe-disease cohort. Because of the limited number of outcome events and the absence of external validation, the model should be considered exploratory and should not yet be used as a clinical decision rule.