OBJECTIVE To analyze the risk factors for severe adenovirus pneumonia (AP) in children and construct a nomogram.

METHODS A total of 108 children with AP admitted to the Department of Infectious Diseases at Children′s Hospital of Nanjing Medical University from Nov. 2023 to Apr. 2024 were selected and divided into a severe group (n=38) and a non-severe group (n=70) based on disease severity. Logistic regression analysis was used to identify the risk factors for severe AP in children. A nomogram was developed by R software, and its performance was evaluated by the receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow goodness-of-fit test.

RESULTS Anemia (OR=4.370, 95% CI: 1.370-13.941, P=0.013), congenital heart disease (OR=4.036, 95% CI: 1.277-12.754, P=0.017), multiple infection (OR=4.984, 95% CI: 1.546-16.069, P=0.007) and pulmonary consolidation (OR=17.492, 95% CI: 5.288-57.864, P < 0.001) were identified as risk factors for severe AP in children. The area under the ROC curve of the nomogram for predicting severe AP in children was 0.896 (95% CI: 0.838-0.954). The slope of calibration curve was close to 1, and the Hosmer-Lemeshow goodness-of-fit test yielded χ²=7.754, P=0.355.

CONCLUSIONS Anemia, congenital heart disease, multiple infection and pulmonary consolidation are risk factors for severe AP in children. The constructed nomogram enables individualized prediction of severe AP risk in children, thereby guiding personalized interventions.