The Clinical Characteristics and Predictors of Refractory Mycoplasma pneumoniae Pneumonia in Children

Abstract

ObjectiveTo analyze the clinical characteristics of refracory Mycoplasma pneumoniae pneumonia (RMPP), and explore the related factors predicting RMPP.MethodsRetrospective analysis was performed on 634 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our hospital between January 1, 2011 and December 31, 2014. The clinical features, laboratory data, radiological findings between the RMPP group and the general Mycoplasma pneumoniae pneumonia (GMPP) group were compared and the predictive values of related factors were analyzed.ResultsThe median age of the RMPP patients (n = 145) was much older than that of the GMPP patients (n = 489) (P<0.01). We also found more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings in RMPP group, which needed oxygen more often, longer antibiotics administration and intensive care (P<0.05). Meanwhile, the levels of C-reactive protein (CRP), lactic dehydrogenase (LDH), immunoglobulin A (IgM), interleukin (IL)-6, IL-10, interferon gamma (IFN-γ) and the percentage of neutrophils, CD8+ in RMPP group were significantly higher than those in GMPP group (P<0.05); while the levels of prealbumin (PAB) were lower than that in GMPP group (P<0.01). In ROC curve analysis, the percentage of neutrophil, CRP, LDH, PAB, IL-6, IL-10 and IFN-γ were useful for differentiating patients with RMPP from those with GMPP. Multiple logistic regression analysis showed that the CRP≥16.5mg/L, LDH ≥417IU/L and IL-6 ≥14.75pg/ml were significant predictors regarding to RMPP.ConclusionsCRP≥16.5mg/L, LDH ≥417IU/L and IL-6 ≥14.75pg/ml might be the significant predictors of RMPP in children, which can aid in early recognition of RMPP.

Development and validation of a simple‐to‐use nomogram for predicting refractoryMycoplasma pneumoniaepneumonia in children

“…What is more, our study mainly focused on the clinical, laboratory, and radiological features of children while the baseline information was not significantly different in this study. One previous study showed that the median age was significantly different between the GMPP and RMPP groups, although it was not found to be an independent risk factor 8 . We still need to pay attention to the relevant baseline information and update our model in the future.…”

“…Although the mechanism of RMPP is not clear, it is widely accepted that inflammatory reactions and immune responses may play an important role in the progress of RMPP. Biomarkers related to inflammatory reactions were evaluated by previous studies 8–12 . CRP, LDH, and IL‐6 were found to be associated with high risk of RMPP in children through an ordinal logistic regression procedure 8 .…”

“…[8][9][10][11][12] CRP, LDH, and IL-6 were found to be associated with high risk of RMPP in children through an ordinal logistic regression procedure. 8 Other factors of clinical symptoms and radiological examinations were also found to be associated with RMPP. 8 However, there is no predictive model with good diagnostic ability for RMPP till now.…”

The clinical characteristics of corticosteroid-resistant refractory Mycoplasma Pneumoniae pneumonia in children

“…LDH was a variable that is universally elevated in many pulmonary diseases and was reported to be associated with disease severity in several studies1415. Previous studies had identified higher levels of LDH as a risk factor for RMPP161718. CRP is a gross biochemical index of inflammation and is used commonly in the clinical setting.…”

Cytokines as the good predictors of refractory Mycoplasma pneumoniae pneumonia in school-aged children

“…Chest radiography was performed before admission or during hospitalization using standard equipment and radiographic techniques. Large lesion was defined when the extent of infiltration on chest radiography was more than 1/3 of the lung21. All patients were treated initially with macrolides (azithromycin or erythromycin) for 5–7 consecutive days or partly with beta-lactam antibiotics (ampicillin with sulbactam or ceftriaxone) simultaneously.…”