Unresolved atelectasis in refractory Mycoplasma pneumoniae pneumonia: Predictive factors and the influence of corticosteroids and bronchoscopy lavage therapy

Abstract

Background Unresolved atelectasis occurs in some children with refractory mycoplasma pneumoniae pneumonia (RMPP). The aim was to analyze factors predicting unresolved atelectasis in RMPP and the impact of corticosteroids and bronchoscopy lavage therapy (BLT) on developing atelectasis. MethodsWe retrospectively analyzed data for 230 pediatric RMPP from January 2013 to June 2017 in Beijing Children's Hospital. In this study, we diagnosed RMPP when patients' clinical and radiological findings deteriorated after 7 days of macrolide therapy, peripheral blood C-reactive protein (CRP) was higher than 40mg/L, and chest imaging showed consolidation with high density > 1/2 pulmonary lobe.We divided patients into two groups according to the presence/absence of atelectasis on chest imaging after a 6-month follow-up. We calculated the predictive value of fever duration, levels of CRP and lactate dehydrogenase (LDH), and the size of lobe consolidation, regarding atelectasis.Additionally, we compared the starting time and dosage of corticosteroids and the starting time of BLT between the two groups.Results Ninety-five patients developed atelectasis (atelectasis group/group A), and 135 patients did not (non-atelectasis group/group NA). Chest imaging showed > 2/3 pulmonary lobe consolidation in 93.7% of patients in group A and 54.1% of patients in group NA. Multiple logistic regression analysis showed that fever duration, CRP and LDH levels, and lobe consolidation were related to developing atelectasis. Areas under the curve revealed that CRP ≥ 137 mg/L had 82.11% sensitivity and 80.07% specificity, and LDH ≥ 471 IU/L had 62.65% sensitivity and 60.31% specificity to predict atelectasis.Fewer patients receiving corticosteroids and BLT within 10 days after illness onset developed atelectasis.Conclusions Fever duration>10 days, CRP and LDH levels, and lobe consolidation are risk factors for developing atelectasis in RMPP. CRP ≥ 137 mg/L, LDH ≥ 471 IU/L, and >2/3 pulmonary lobe consolidation were significant predictors of atelectasis, which can aid in early recognition.Corticosteroid administration and subsequent BLT within 10 days of the disease onset, and increased corticosteroid dosage may help reduce the incidence of atelectasis in these RMPP patients.

Profile of proinflammatory cytokines in children with Mycoplasma pneumoniae pneumonia

“…The neutrophil count and CRP level in PB reflects the degree of infection and inflammation. In this study, we found that the absolute counts of neutrophils and CRP levels in PB of children with SMPP were significantly higher than those in NSMPP patients, which was consistent with that obtained at the Beijing Children's Hospital [20].…”

Mycoplasma pneumoniae​ pneumonia associated thrombosis at Beijing Children’s Hospital

“…This suggests that SMPP is the most strongly associated risk factor for MPassociated thrombosis. The severity of MPP was associated with fever duration, the levels of inflammatory markers such as CRP and LDH, and the severity of radiography findings such as lobar consolidation [21][22][23][24] , which are strongly correlated with measures of the severity of airway damage such as mucous necrosis and subsequent airway remodeling [4] . The present study again confirmed the above associations, and the presence of an excessive systemic and local airway immune response in SMPP.…”

“…Biomarkers such as CRP and D-dimer levels were close related to severity of CAP [4,22,23,27] . Plasma D-dimer is a degradation product of cross-linked fibrin and D-dimer values are elevated in the presence of acute clots [28] .…”

Insights into the Therapeutic of Glucocorticoid for Refractory Mycoplasma Pneumoniae Pneumonia in Children

“…LDH was associated with many lung diseases, such as obstructive and interstitial lung diseases [40,41] . Several studies [1,3,42,43] also found that serum LDH was elevated in RMPP. In our study, we found that the area under the curve of LDH was 0.734 in ROC curve analysis, showing fair discriminative power for predicting RMPP.…”