Construction of a Nomogram Model for Risk Assessment of Immune Checkpoint Inhibitor- Related Pneumonitis: A Study Based on Clinical Data

Construction of a Nomogram Model for Risk Assessment of Immune Checkpoint Inhibitor- Related Pneumonitis: A Study Based on Clinical Data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Construction of a Nomogram Model for Risk Assessment of Immune Checkpoint Inhibitor- Related Pneumonitis: A Study Based on Clinical Data Dongzhu Lu, ShiJie Chen, Yaping Hong, JinLan Lin, YunJian Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8333059/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Immune checkpoint inhibitor (ICI) therapy-related pneumonitis (CIP) is a rare and potentially lethal side effect associated with ICIs. This study aimed to develop and validate a noninvasive nomogram for the identification of independent risk factors for CIP in advanced non-small cell lung cancer (NSCLC) patients treated with ICIs. Methods This study retrospectively enrolled 73 patients with advanced NSCLC and CIP and 583 healthy controls. All patients were randomized into a training set (n = 420) and a test set (n = 181) at a ratio of 7:3. Univariate and binary logistic regression analyses were used to determine independent risk factors and to construct a prediction model. Internal validation was evaluated using the area under the curve (AUC), a calibration curve and decision curve analysis (DCA). Results Binary logistic regression analysis revealed that the risk factors for CIP were red blood cell distribution width (RDW) (odds ratio [OR], 6.242; 95% CI: 2.661–14.645), absolute eosinophils count (EOS) (OR, 5.453; 95% CI: 1.732–17.170), lactate dehydrogenase (LDH) (OR, 14.032; 95% CI: 5.562–35.395), fibrinogen (Fib) (OR, 4.951; 95% CI: 2.213–11.073) and the use of antibiotics (OR, 6.449; 95% CI: 2.746–15.145). A nomogram model was constructed for CIP based on these risk factors, and the AUC was 0.918 (95% CI: 0.877–0.958). Therefore, the model shows good differentiation, calibration and clinical value. Conclusions A noninvasive predictive nomogram was developed and validated to help clinicians predict the risk of CIP in patients treated with ICIs. Trial registration Not applicable. Immune checkpoint inhibitor Pneumonitis Risk factors Nomogram Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 06 Feb, 2026 Reviewers invited by journal 29 Jan, 2026 Editor invited by journal 09 Jan, 2026 Editor assigned by journal 16 Dec, 2025 Submission checks completed at journal 16 Dec, 2025 First submitted to journal 11 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8333059","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582449376,"identity":"ef627e70-ec5c-416c-b5bc-039f1eadba54","order_by":0,"name":"Dongzhu Lu","email":"","orcid":"","institution":"Clinical Oncology School of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dongzhu","middleName":"","lastName":"Lu","suffix":""},{"id":582449379,"identity":"ae67a2d6-d922-467f-8a4f-61851df1e790","order_by":1,"name":"ShiJie Chen","email":"","orcid":"","institution":"Clinical Oncology School of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"ShiJie","middleName":"","lastName":"Chen","suffix":""},{"id":582449380,"identity":"cda816f6-cc47-4596-8d38-35007a34e6df","order_by":2,"name":"Yaping Hong","email":"","orcid":"","institution":"Clinical Oncology School of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yaping","middleName":"","lastName":"Hong","suffix":""},{"id":582449381,"identity":"85cceaf4-5dfc-4abe-b1b3-462e6f2f3005","order_by":3,"name":"JinLan Lin","email":"","orcid":"","institution":"Clinical Oncology School of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"JinLan","middleName":"","lastName":"Lin","suffix":""},{"id":582449382,"identity":"539a883a-592d-4442-b8e5-7fedbc02b8a2","order_by":4,"name":"YunJian Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYJACgwQGBh559sbGBx9I0SJj2HO42XAGKTbZMNxIb5PmIMqGG7kHCh7U3OFhnPmwQZqBwU5Ot4GglrwEg4Rjz3jYpRMbjAsYko3NDhDUkmNgkMB2mIdxdmJD8gyGA4nbiNPy7zAPw82DDUCSWC2JbUDFNxgbm4nSInnmDVBL32Eew57EZsYZBkT4he94jpnhj2+H7eXZjz//8aHCTo6gFoUDDGwGSO4koBwE5BsYmB8QoW4UjIJRMApGMgAArjlG9yEm4vgAAAAASUVORK5CYII=","orcid":"","institution":"Clinical Oncology School of Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"YunJian","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2025-12-11 06:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8333059/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8333059/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101754180,"identity":"95c0d564-c395-40c3-84b3-9ab41de741fd","added_by":"auto","created_at":"2026-02-03 10:41:53","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":623048,"visible":true,"origin":"","legend":"","description":"","filename":"ConstructionofaNomogramModelforRiskAssessmentofImmuneCheckpointInhibitorRelatedPneumonitisAStudyBasedonClinicalData.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8333059/v1_covered_26b2b4bd-3103-4405-852b-0513bc5775f7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Construction of a Nomogram Model for Risk Assessment of Immune Checkpoint Inhibitor- Related Pneumonitis: A Study Based on Clinical Data","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Immune checkpoint inhibitor, Pneumonitis, Risk factors, Nomogram","lastPublishedDoi":"10.21203/rs.3.rs-8333059/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8333059/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eImmune checkpoint inhibitor (ICI) therapy-related pneumonitis (CIP) is a rare and potentially lethal side effect associated with ICIs. This study aimed to develop and validate a noninvasive nomogram for the identification of independent risk factors for CIP in advanced non-small cell lung cancer (NSCLC) patients treated with ICIs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study retrospectively enrolled 73 patients with advanced NSCLC and CIP and 583 healthy controls. All patients were randomized into a training set (n\u0026thinsp;=\u0026thinsp;420) and a test set (n\u0026thinsp;=\u0026thinsp;181) at a ratio of 7:3. Univariate and binary logistic regression analyses were used to determine independent risk factors and to construct a prediction model. Internal validation was evaluated using the area under the curve (AUC), a calibration curve and decision curve analysis (DCA).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBinary logistic regression analysis revealed that the risk factors for CIP were red blood cell distribution width (RDW) (odds ratio [OR], 6.242; 95% CI: 2.661\u0026ndash;14.645), absolute eosinophils count (EOS) (OR, 5.453; 95% CI: 1.732\u0026ndash;17.170), lactate dehydrogenase (LDH) (OR, 14.032; 95% CI: 5.562\u0026ndash;35.395), fibrinogen (Fib) (OR, 4.951; 95% CI: 2.213\u0026ndash;11.073) and the use of antibiotics (OR, 6.449; 95% CI: 2.746\u0026ndash;15.145). A nomogram model was constructed for CIP based on these risk factors, and the AUC was 0.918 (95% CI: 0.877\u0026ndash;0.958). Therefore, the model shows good differentiation, calibration and clinical value.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eA noninvasive predictive nomogram was developed and validated to help clinicians predict the risk of CIP in patients treated with ICIs.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Construction of a Nomogram Model for Risk Assessment of Immune Checkpoint Inhibitor- Related Pneumonitis: A Study Based on Clinical Data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 19:29:44","doi":"10.21203/rs.3.rs-8333059/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"248477050645960585018349651091144198543","date":"2026-02-06T08:02:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T12:25:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-09T16:26:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-16T11:49:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-16T11:49:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-12-11T05:57:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a7602db-aa7e-4f6c-bb12-fe71924ada0f","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T19:29:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 19:29:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8333059","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8333059","identity":"rs-8333059","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}