{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:27:40Z","timestamp":1786116460609,"version":"build-2736575974"},"reference-count":22,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007824","name":"Soochow University","doi-asserted-by":"publisher","award":["LCZX202313"],"award-info":[{"award-number":["LCZX202313"]}],"id":[{"id":"10.13039\/501100007824","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>The study screened clinical and laboratory indicators accessible within 48 h of admission for children with Epstein\u2013Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and macrophage activation syndrome (MAS) to establish an efficient and convenient differential diagnosis model. The study retrospectively analyzed the clinical data and laboratory results obtained within 48 h of admission from 106 pediatric patients initially hospitalized and diagnosed with EBV-HLH or MAS at the Children\u2019s Hospital of Soochow University from January 2019 to November 2024. Univariate logistic regression and LASSO regression filtered the variables alongside cross-validation and dimensionality reduction. The final regression model constructed a predictive nomogram, calibration curve, ROC curve, and DCA curve to evaluate the discrimination capacity and net clinical benefit of the model. Univariate logistic regression, LASSO regression with five-fold cross-validation, and stepwise multivariate logistic regression identified skin rash, bone marrow hemophagocytosis, fibrinogen, neutrophil percentage, and hepatosplenomegaly as the core predictors for differentiating EBV-HLH from MAS. The constructed nomogram and diagnostic calculator demonstrated favorable discriminative ability, with an area under the receiver operating characteristic curve of 0.938 (95% CI: 0.894\u20130.974). The calibration curve showed good agreement between predicted probabilities and actual observed outcomes, yielding a Brier score of 0.099. Decision curve analysis indicated that the model provided a significant positive net clinical benefit across a risk threshold range of 5% to 95%. A simple scoring system based on common clinical indicators effectively distinguished EBV-HLH from immune-related HLH in the early stages and guided initial treatment decisions.<\/jats:p>","DOI":"10.3390\/pathogens15080828","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T09:46:38Z","timestamp":1786009598000},"page":"828","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Differential Diagnosis of Epstein\u2013Barr Virus-Associated Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome in Children: A Clinical Prediction Model Based on 106 Patients"],"prefix":"10.3390","volume":"15","author":[{"given":"Mengjia","family":"Pei","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University, Suzhou 215006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuewen","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University, Suzhou 215006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaying","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University, Suzhou 215006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6088-4977","authenticated-orcid":false,"given":"Weifang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University, Suzhou 215006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chu","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University, Suzhou 215006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/imr.13298","article-title":"Hemophagocytic lymphohistiocytosis: A disorder of T cell activation, immune regulation, and distinctive immunopathology","volume":"322","author":"Jordan","year":"2024","journal-title":"Immunol. 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