Fig 1.
Study design and modeling workflow.
Development set (2011-2020, N = 1,435) randomly split into training (N = 1,004) and internal validation (N = 431) sets; Independent testing set (2021-2023, N = 457). Cox regression-derived nomogram evaluated by receiver operating characteristic curves, calibration plots, and decision curve analysis.
Table 1.
Baseline characteristics of study participants.
Fig 2.
Independent predictors of poor outcome.
Forest plot showing adjusted hazard ratios (aHR) and 95% confidence interval (95% CI): absence of lymphadenopathy (aHR 0.581, 95% CI 0.396-0.852), absence of hepatosplenomegaly (aHR 0.347, 95% CI 0.232-0.519), elevated breath rate (per breath/min increase: aHR 1.041, 95% CI 1.007-1.076), increased white blood cell count (per 1 × 10⁹/L increase: aHR 1.089, 95% CI 1.049-1.132), decreased platelet count (per 1 × 10⁹/L decrease: aHR 0.995, 95% CI 0.992-0.997), hypoalbuminemia (per 1 g/L decrease: aHR 0.911, 95% CI 0.872-0.952), elevated lactate dehydrogenase (per 1 U/L increase: aHR 1.000, 95% CI 1.000-1.000), and increased blood urea nitrogen (per 1 mmol/L increase: aHR 1.087, 95% CI 1.068-1.106). All P < 0.05. For clinical application, these continuous variables will be categorized before developing the nomogram.
Fig 3.
Survival analysis by predictor stratification.
(A-H) Significant differences in poor outcome risk across stratified groups of lymphadenopathy, hepatosplenomegaly, tachypnea, white blood cell count, platelet count, albumin, lactate dehydrogenase, and blood urea nitrogen (all log-rank P < 0.001).
Fig 4.
Dynamic nomogram for risk prediction.
Clinical tool integrating eight stratified predictors to estimate 7-day/14-day/28-day poor outcome probabilities.
Fig 5.
Receiver operating characteristic curve analysis of the prognostic model.
(A) Training set: 7-day area under the curve (95% confidence interval) = 0.905 (0.864-0.946), 14-day = 0.863 (0.815-0.911), 28-day = 0.838 (0.794-0.883); Concordance index = 0.841 (0.802-0.880). (B) Internal validation set: 7-day area under the curve = 0.901 (0.849-0.952), 14-day = 0.883 (0.830-0.937), 28-day = 0.829 (0.761-0.897); Concordance index = 0.838 (0.785-0.891). (C) Independent testing set: 7-day area under the curve = 0.851 (0.777-0.925), 14-day = 0.832 (0.762-0.902), 28-day = 0.807 (0.736-0.878); Concordance index = 0.813 (0.754-0.872).
Fig 6.
Risk stratification survival analysis.
(A-C) Significant difference in survival probability between high-risk and low-risk groups defined by nomogram scores in (A) training, (B) internal validation, and (C) independent testing sets (all log-rank P < 0.001).