Analysis of Risk Factors and Construction of a Prediction Model for Pulmonary Atelectasis Complicating Pediatric Severe Pneumonia by Integrating a Quantitative Lung Ultrasound Score with Routine Parameters

Introduction. To integrate the Lung Ultrasound Score (LUSS) with routine parameters to analyze the risk factors for pulmonary atelectasis in children with severe pneumonia (SP) and to construct a predictive model. Methods. A retrospective analysis was conducted on 215 children with SP who underwent lung ultrasound examination at the Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China, between September 2022 and June 2025. Based on the occurrence of atelectasis during hospitalization, the patients were categorized into an atelectasis group and a non-atelectasis group. Data collected within 48 hours of admission included general information, clinical data, laboratory parameters, and imaging findings. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for the development of atelectasis. Subsequently, a nomogram was developed and validated. Results. Among the 215 children with SP, 75 (34.88%) developed atelectasis. The LUSS, alanine aminotransferase (ALT), and α-hydroxybutyrate dehydrogenase (α-HBDH) were significantly associated with the occurrence of atelectasis complicating SP (p < 0.05). Receiver operating characteristic (ROC) curve analysis of the constructed nomogram model demonstrated that the combination of these three factors for predicting atelectasis yielded a sensitivity of 84.0%, a specificity of 65.0%, and an area under the curve (AUC) of 0.790 (95% CI: 0.728~0.846; p < 0.05). The Hosmer-Lemeshow test yielded a p-value of 0.102, indicating that the model possesses strong predictive capability. Conclusions. The model established in this study can be utilized to predict the risk of pulmonary atelectasis in children with SP. When children with SP present concurrently with severe lung ultrasound findings and elevated ALT and α-HBDH levels, a high degree of vigilance for the potential development of atelectasis is warranted, necessitating early personalized intervention.