Abstract
BackgroundIn children, refractory Mycoplasma pneumoniae pneumonia (RMPP) may result in severe complications and high medical costs. There is research on a simple and easy-to-use nomogram for early prediction and timely treatment of RMPP.MethodsFrom December 2018 to June 2021, we retrospectively reviewed medical records of 299 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in Tianjin Children's Hospital. According to their clinical manifestations, patients were divided into the RMPP group and the general Mycoplasma pneumoniae pneumonia (GMPP) group. The clinical manifestations, laboratory indicators, and radiological data of the two groups were obtained. Stepwise regression was employed for variable selection of RMPP. The predictive factors selected were used to construct a prediction model which presented with a nomogram. The performance of the prediction model was evaluated by C statistics, calibration curve, and receiver operating characteristic (ROC) curve.ResultsThe RMPP group significantly showed a higher proportion of females, longer fever duration, and longer hospital stay than the GMPP group (P < 0.05). Additionally, the RMPP group revealed severe clinical characteristics, including higher incidences of extrapulmonary complications, decreased breath sounds, unilateral pulmonary consolidation >2/3, and plastic bronchitis than the GMPP group (P < 0.05). The RMPP group had higher neutrophil ratio (N%), C-reactive protein (CRP), interleukin-6 (IL-6), lactic dehydrogenase (LDH), and D-dimer than the GMPP group (P < 0.05). Stepwise regression demonstrated that CRP [OR = 1.075 (95% CI: 1.020–1.133), P < 0.001], LDH [OR = 1.015 (95% CI: 1.010–1.020), P < 0.001], and D-dimer [OR = 70.94 (95% CI: 23.861–210.904), P < 0.001] were predictive factors for RMPP, and developed a prediction model of RMPP, which can be visualized and accurately quantified using a nomogram. The nomogram showed good discrimination and calibration. The area under the ROC curve of the nomogram was 0.881, 95% CI (0.843, 0.918) in training cohorts and 0.777, 95% CI (0.661, 0.893) in validation cohorts, respectively.ConclusionC-reactive protein, LDH, and D-dimer were predictive factors for RMPP. The simple and easy-to-use nomogram assisted us in quantifying the risk for predicting RMPP, and more accurately and conveniently guiding clinicians to recognize RMPP, and contribute to a rational therapeutic choice.
Highlights
Mycoplasma pneumoniae (MP)-related respiratory tract infections in children have increased significantly worldwide, and 10–40% of these infections will develop into Mycoplasma pneumoniae pneumonia (MPP) [1,2,3], of which pleural effusion, plastic bronchitis, and atelectasis are all possible complications during the acute stage, as are necrotizing pneumonia, pulmonary thromboembolism, lung abscess, and other severe complications [4, 5]
The MPP patients were divided into two groups: general Mycoplasma pneumoniae pneumonia (GMPP) group and refractory Mycoplasma pneumoniae pneumonia (RMPP) group
Our analysis revealed that the RMPP group had decreased breath sounds, unilateral pulmonary consolidation >2/3 radiologically, and higher levels of N% and IL-6 than the GMPP group, the incidence of plastic bronchitis, extrapulmonary complications, and length of stay in the hospital were significantly higher than the GMPP group, with statistically significant differences
Summary
Mycoplasma pneumoniae (MP)-related respiratory tract infections in children have increased significantly worldwide, and 10–40% of these infections will develop into Mycoplasma pneumoniae pneumonia (MPP) [1,2,3], of which pleural effusion, plastic bronchitis, and atelectasis are all possible complications during the acute stage, as are necrotizing pneumonia, pulmonary thromboembolism, lung abscess, and other severe complications [4, 5]. Some children had poor responses to conventional MPP treatment, presenting as refractory Mycoplasma pneumoniae pneumonia (RMPP). Recurrent respiratory tract infections, and asthma with RMPP have caused great pain to patients, increased medical burden, and posed great challenges for clinicians [9]. This hot spot, difficult issue is more prominent in Asia, in China. Refractory Mycoplasma pneumoniae pneumonia (RMPP) may result in severe complications and high medical costs.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
