Construction of predictive model for recurrent respiratory tract infections based on children’s nutrition-related indicators and its validation analysis
HU Guanqiong, JIA Xiumei, HUANG Junlin
Department of Children's Outpatient and Emergency, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
HU Guanqiong,JIA Xiumei,HUANG Junlin. Construction of predictive model for recurrent respiratory tract infections based on children’s nutrition-related indicators and its validation analysis[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2022, 52(2): 109-114，120.
Abstract：Objective: To construct and validate a predictive model for recurrent respiratory tract infection based on nutrition-related indicators in children. Method: Altogether 283 children with respiratory infections admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to March 2020 were selected as the research subjects, and all received standardized treatment. They were divided into the recurrent respiratory infection group and the non-recurrent respiratory infection group according to whether the respiratory tract infection recurred or not, with 198 cases (70%) and 85 cases (30%) randomly selected as training set and test set respectively. Their clinical data were compared, and the logistic regression model was used to analyze the related factors of recurrent respiratory infection. And a nomogram prediction model was built on the training set, using decision curve analysis to evaluate the clinical net benefits of the Nomogram model, and the effectiveness of the model was evaluated on the test set. Results: The ratio of family history of chronic respiratory diseases, birth weight, outdoor activity time, breastfeeding time, hemoglobin, vitamin A, vitamin D levels were statistically different (P<0.05). There was no significant difference in gender, age, body mass index, place of residence, birth method, asphyxia, sleep time, white blood cell count, serum zinc, iron, calcium, and magnesium (P>0.05). Multivariate logistic analysis showed that high birth weight (OR=0.995, P=0.004), long time outdoor activity (OR=0.630, P=0.003), increased hemoglobin level (OR=0.846, P<0.001), increased vitamin A level (OR=0.437, P<0.001), increased vitamin D level (OR=0.938, P=0.007) were protective factors for children with repeated respiratory infections. The C-index of the Nomogram model constructed to predict recurrent respiratory tract infection was 0.869 (95%CI=0.818-0.920). Decision curve analysis made to evaluate the clinical benefits of the two prediction models showed that additional clinical benefits could be provided when the value of nutrition-related indicators to predict children with recurrent respiratory tract infection fell within the range 0-0.59. External verification showed that the sensitivity was 92.00% and the specificity 96.67%, with the accuracy rate being 95.29%. Conclusion: Higher birth weight, prolonged outdoor activities, elevated levels of hemoglobin, vitamin A and vitamin D were protective factors for children with recurrent respiratory infections. The Nomogram model constructed with vitamin A and vitamin D nutritional indicators can improve the predicting accuracy for recurrent respiratory tract infections in children.
