Abstract: Objective To investigate the predictive value of adenovirus (ADV) load in the development of severe adenovirus pneumonia (SAP) to bronchiolitis obliterans (BO).Methods A total of 139 SAP children admitted to Children's Hospital of Chongqing Medical University from January 2015 to February 2019 were enrolled, of which 34 developed into BO and 105 did not. LASSO-logistic regression, restricted cubic spline model and decision curve analysis were used to evaluate the clinical predictive value of ADV load in the development of SAP to BO.Results The duration of fever, respiratory failure, invasive mechanical ventilation, ADV-DNA load of nasopharyngeal aspirate, PCT and bacterial infection were compared between the two groups (P<0.05). The variables were screened by LASSO-logistic regression, and multivariate logistic regression analysis showed that the ADV load of nasopharyngeal aspirate was an independent risk factor for SAP developing into BO (OR=1.247, 95% CI: 1.088~1.459, P=0.01). Restricted cubic spline analysis showed a linear dose-response relationship between the natural logarithm of the nasopharyngeal aspirate ADV load and the post-SAP developmental BO (linear test, P=0.69). Decision curve analysis showed that ADV load had important clinical value for the prediction of SAP developing into BO.Conclusion ADV load is an independent, dose-dependent risk factor for the development of childhood SAP to BO, and has important clinical value for the prediction of SAP developing into BO.

Key words: Adenovirus, Bronchiolitis obliterans, Decision curve analysis, Dose-response analysis, Severe adenovirus pneumonia