Age-specific profiles and ICU predictors in pediatric plastic bronchitis: A multicenter Chinese cohort study, 2014–2025

INTRODUCTION AND AIM: Plastic bronchitis (PB) is a rare yet critical respiratory condition in children, with age-specific clinical profiles and predictors for severe progression remaining poorly characterized. METHODS: This multicenter, retrospective study analyzed 180 pediatric PB cases (2014-2025), categorizing patients into nursing (0-3 years), pre-school (>3-6 years), and school-age (≥6 years) groups. We compared demographics, clinical features, laboratory findings, and outcomes across these cohorts. Independent risk factors for ICU admission were identified via multivariate logistic regression. RESULTS: Nursing children presented with more severe respiratory distress, exhibiting significantly higher rates of wheezing, dyspnea, and ICU admission (all P < 0.05) compared to older groups. Mycoplasma pneumoniae detection was more common in pre-school and school-age children (P < 0.001), whereas Human Bocavirus was predominant in nursing children (P = 0.001). Multivariable analysis identified prolonged hospitalization (OR 1.141, P < 0.001), elevated aspartate aminotransferase (AST) (OR 1.004, P = 0.028), and influenza A/B infection (OR 8.563, P = 0.001) as independent risk factors for ICU admission. CONCLUSION: This study, representing the largest PB cohort to date, reveals that nursing children constitute a high-risk subgroup with distinct virologic patterns. Influenza infection, elevated AST, and extended hospital stay serve as key predictors for ICU care, underscoring the necessity of age-specific management protocols in pediatric PB.