Respiratory medicine · 2026
Early identification of severe Mycoplasma pneumoniae pneumonia in children: A retrospective model development study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Dong Zijuan, Zhang Xiaojuan, Gu Lina, Ma Yanqiu, Zhang Jiajia, Si Qiuyuan, Xiang Hongxia, Kang Yan-Jun
Аннотация
BACKGROUND: A nationwide resurgence of pediatric Mycoplasma pneumoniae pneumonia (MPP) has been observed in China since mid-2023, yet contemporary tools for early recognition of severe MPP (SMPP) are lacking.
METHODS: In this retrospective study we analyzed 908 children (≤14 years) hospitalized with MPP at Wuxi Children's Hospital between August 2023 and August 2024. Demographic, clinical, laboratory and medication features were compared between SMPP (n = 277) and non-SMPP (n = 631) groups. Independent predictors were identified by stepwise logistic regression and incorporated into a five-parameter nomogram. Internal validity was assessed with 1000-bootstrap resampling.
RESULTS: SMPP accounted for 30.5 % of all admissions. Multivariable analysis showed that higher neutrophil percentage (OR = 1.02 per %, 95% CI 1.01-1.03), older age (OR = 1.21 per year, 95% CI 1.12-1.28), longer pre-admission azithromycin exposure (OR = 1.34 per day, 95% CI 1.11-1.37), higher peak temperature (OR = 1.37 per °C, 95% CI 1.07-1.75) and elevated lactate dehydrogenase (LDH) (OR = 1.24 per 100 U/L, 95 % CI 1.04-1.47) independently predicted SMPP (all P < 0.05). The optimism-corrected area under the ROC curve (AUC) was 0.75 (95% CI 0.72-0.78); the calibration slope was 0.96, intercept 0.02, and Brier score 0.04.
CONCLUSIONS: Almost one-third of children admitted with MPP during the 2023-2024 outbreak developed severe disease. A five-parameter nomogram based on routinely available admission data provides accurate, internally validated risk estimation and may facilitate timely escalation of care. External validation and prospective evaluation of macrolide resistance are required before large-scale implementation.
METHODS: In this retrospective study we analyzed 908 children (≤14 years) hospitalized with MPP at Wuxi Children's Hospital between August 2023 and August 2024. Demographic, clinical, laboratory and medication features were compared between SMPP (n = 277) and non-SMPP (n = 631) groups. Independent predictors were identified by stepwise logistic regression and incorporated into a five-parameter nomogram. Internal validity was assessed with 1000-bootstrap resampling.
RESULTS: SMPP accounted for 30.5 % of all admissions. Multivariable analysis showed that higher neutrophil percentage (OR = 1.02 per %, 95% CI 1.01-1.03), older age (OR = 1.21 per year, 95% CI 1.12-1.28), longer pre-admission azithromycin exposure (OR = 1.34 per day, 95% CI 1.11-1.37), higher peak temperature (OR = 1.37 per °C, 95% CI 1.07-1.75) and elevated lactate dehydrogenase (LDH) (OR = 1.24 per 100 U/L, 95 % CI 1.04-1.47) independently predicted SMPP (all P < 0.05). The optimism-corrected area under the ROC curve (AUC) was 0.75 (95% CI 0.72-0.78); the calibration slope was 0.96, intercept 0.02, and Brier score 0.04.
CONCLUSIONS: Almost one-third of children admitted with MPP during the 2023-2024 outbreak developed severe disease. A five-parameter nomogram based on routinely available admission data provides accurate, internally validated risk estimation and may facilitate timely escalation of care. External validation and prospective evaluation of macrolide resistance are required before large-scale implementation.