Children
Interpretable Modelling of a Streptococcal Exposure-Associated Neuropsychiatric Profile in a Pediatric Cohort
By Schiopu CG, Dobre CE, Cantemir DA and 7 others.
Abstract
Background/objectives
Pediatric neuropsychiatric presentations in the context of suspected previous streptococcal exposure remain clinically heterogeneous. This study examined whether a predefined clinical-serological profile could be reconstructed within a naturalistic psychiatric cohort using interpretable supervised models and whether discrimination persisted after removing endpoint-proximal predictors.
Methods
This secondary exploratory analysis included 96 children and adolescents evaluated in Romanian psychiatric inpatient and outpatient settings. The operational endpoint required PANS-31 > 36, antistreptolysin O (ASO) > 200 IU/mL, abrupt symptom onset or worsening, and a reported streptococcal episode within six months; 24 participants met all four conditions. Infection history was derived from caregiver reports and available medical documentation. Logistic Regression, Random Forest, and XGBoost were evaluated using stratified five-fold cross-validation and a 70/30 training-test split. Full-feature models included 27 predictors, whereas restricted-feature models were refitted after excluding continuous ASO, infection recency, and abrupt onset. SHAP was used to examine feature attribution.