Canadian respiratory journal · 2026
Clinical Prediction of Necrotizing Pneumonia in Children With Mycoplasma pneumoniae: A Model Based on Early Response to Therapy.
СтатьяНазвание и аннотация: Перевод в очереди
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Zheng Jia Feng, Zhang Meng Yao, Dong Han Quan, Wang Bo, Xu Yong Sheng
Аннотация
OBJECTIVE: This study aimed to identify factors that predict progression to necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) who fail to respond to initial therapy and to develop a predictive model to support early clinical decision-making.
METHODS: We retrospectively analyzed clinical and laboratory data of children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) admitted to Tianjin Children's Hospital from January 2021 to January 2025. MUMPP was defined as persistent fever (≥ 38.5°C, lasting ≥ 4 h/day) after ≥ 72 h of standardized intravenous macrolide therapy. Patients were classified into an observation group (n = 106, those who developed NP) and a control group (n = 130, those who did not). Independent predictors of NP were identified by multivariable logistic regression and incorporated into a nomogram. Model performance was evaluated using ROC analysis, calibration plots, and decision curve analysis.
RESULTS: In multivariable analysis, increased white blood cell (WBC) count (OR = 2.484, 95% CI: 1.406-4.613), longer fever duration (OR = 1.618, 95% CI: 1.217-2.193), pleural effusion (OR = 3.955, 95% CI: 1.664-10.00), and elevated C-reactive protein (CRP) (OR = 2.152, 95% CI: 1.547-3.074) were independently associated with NP among children with MPP after initial treatment failure. Calibration curves indicated close agreement between predicted and observed risks in both the derivation cohort (p = 0.588) and the validation cohort (p = 0.424). The model showed good discrimination, with an AUC of 0.848 (95% CI: 0.789-0.908) in the derivation cohort and 0.889 (95% CI: 0.815-0.963) in the validation cohort. Decision curve analysis suggested net clinical benefit across relevant threshold probabilities.
CONCLUSION: Among children with MUMPP, higher WBC count, prolonged fever, pleural effusion, and higher CRP identify increased risk of NP.
METHODS: We retrospectively analyzed clinical and laboratory data of children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) admitted to Tianjin Children's Hospital from January 2021 to January 2025. MUMPP was defined as persistent fever (≥ 38.5°C, lasting ≥ 4 h/day) after ≥ 72 h of standardized intravenous macrolide therapy. Patients were classified into an observation group (n = 106, those who developed NP) and a control group (n = 130, those who did not). Independent predictors of NP were identified by multivariable logistic regression and incorporated into a nomogram. Model performance was evaluated using ROC analysis, calibration plots, and decision curve analysis.
RESULTS: In multivariable analysis, increased white blood cell (WBC) count (OR = 2.484, 95% CI: 1.406-4.613), longer fever duration (OR = 1.618, 95% CI: 1.217-2.193), pleural effusion (OR = 3.955, 95% CI: 1.664-10.00), and elevated C-reactive protein (CRP) (OR = 2.152, 95% CI: 1.547-3.074) were independently associated with NP among children with MPP after initial treatment failure. Calibration curves indicated close agreement between predicted and observed risks in both the derivation cohort (p = 0.588) and the validation cohort (p = 0.424). The model showed good discrimination, with an AUC of 0.848 (95% CI: 0.789-0.908) in the derivation cohort and 0.889 (95% CI: 0.815-0.963) in the validation cohort. Decision curve analysis suggested net clinical benefit across relevant threshold probabilities.
CONCLUSION: Among children with MUMPP, higher WBC count, prolonged fever, pleural effusion, and higher CRP identify increased risk of NP.