Developing a nomogram for predicting chronic complications in pediatric acute suppurative arthritis

Background Pediatric acute suppurative arthritis (ASA) carries a risk of chronic complications, and predicting these complications is crucial for optimizing prognosis. We sought to develop a risk prediction model to identify chronic complications in children with ASA. Methods This retrospective observational study enrolled children (ages one month to 18 years) diagnosed with ASA who were hospitalized at a tertiary pediatric hospital between 2016 and 2023. We documented clinical management, complication status, and sequelae, and constructed a multivariate logistic regression model for predicting chronic complications. Results A total of 95 children were identified, 16.8% of whom experienced chronic complications from ASA over a 12-month follow-up period. Univariate logistic analysis identified the following factors associated with chronic complication development: white blood cell (WBC), serum amyloid A (SAA), hematocrit, hemoglobin, mean platelet volume, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) on admission; SAA, hematocrit (HCT), and hemoglobin (HGB) at discharge; bacteremia; Staphylococcus aureus detection; bone abscess; delayed source control; bone debridement; isolated arthritis; and arthritis combined with dislocation or subluxation (all p < 0.05). On further multivariate logistic regression analysis, we identified four independent predictors: WBC on admission (OR = 1.165, 95% CI: 1.038–1.308), ALT on admission (OR = 1.014, 95% CI: 1.004–1.025), SAA at discharge (OR = 1.153, 95% CI: 1.029–1.292), and arthritis combined with dislocation or subluxation (OR = 28.134, 95% CI: 3.691–214.431). The area under the receiver operating characteristic (ROC) curve was 0.882 (95% CI: 0.786–0.979). The logistic regression model formula was: Log(P) = -8.459 + 0.153×WBC on admission + 0.014×ALT on admission + 0.142×SAA at discharge + 3.337×arthritis combined with dislocation or subluxation. Conclusion The prediction model for chronic complications of pediatric ASA incorporates four key variables: WBC on admission, ALT on admission, SAA at discharge, and arthritis combined with dislocation or subluxation. This model has been shown to effectively predict chronic complication risk in children with ASA.