Construction and validation of a predictive model for recurrent wheezing risk within one year after initial hospitalization for RSV lower respiratory tract infection in preschool children.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in preschool children and is strongly associated with subsequent recurrent wheezing; however, predictive tools for identifying high-risk children are lacking. This study aimed to construct and validate a model for predicting recurrent wheezing within one year after initial hospitalization for RSV LRTI. METHODS: This retrospective study included preschool children with wheezing hospitalized for their first RSV LRTI at our hospital between April 2020 and March 2025. Patients were divided into recurrence and non-recurrence groups based on recurrent wheezing within one year post-discharge. Demographic and clinical data, and serum biomarkers (25-hydroxyvitamin D3 [25-(OH) D3], interleukin-6 [IL-6], interferon-γ [IFN-γ], eosinophil percentage, and other markers) were collected at admission. RESULTS: A total of 480 patients were included, with 276 experiencing recurrence and 204 without. Multivariate analysis identified independent predictors: younger age (OR = 0.398, P = 0.007), passive smoking (OR = 2.802, P = 0.013), longer hospital stay (OR = 1.264, P = 0.003), lower 25-(OH) D3 (OR = 0.766, P < 0.001), higher IL-6 (OR = 1.591, P < 0.001), lower IFN-γ (OR = 0.563, P < 0.001), and higher eosinophil percentage (OR = 1.398, P < 0.001). The nomogram incorporating these factors achieved an AUC of 0.950 (sensitivity 0.912, specificity 0.857) in the training set and 0.940 (sensitivity 0.874, specificity 0.882) in the validation set. CONCLUSION: This nomogram, incorporating age, passive smoking, hospital stay, 25-(OH) D3, IL-6, IFN-γ, and eosinophil percentage, accurately predicts a recurrent wheezing risk and can guide personalized management for preschool children after RSV LRTI.