Frontiers in pediatrics · 2026
Prediction models for refractory Mycoplasma pneumoniae pneumonia and corticosteroid treatment escalation in hospitalized children: a retrospective cohort study.
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Li Yueqian, Shen Yinan, Shi Xiao, Li Yanwei, Li Xuan, Liu Junfeng
Аннотация
BACKGROUND: Mycoplasma pneumoniae carries a clinically important risk of a refractory course or the need for intensified corticosteroid therapy. No admission-day prediction tool has been validated to identify children at risk for either outcome.
METHODS: Children admitted to a single tertiary centre with a diagnosis of MPP between January 2022 and June 2025 were enrolled in a retrospective cohort study. Two penalised logistic regression models were constructed from routine admission-day clinical and laboratory variables: one targeting RMPP occurrence across the full eligible cohort (Cohort A) and one targeting corticosteroid escalation within the treated subgroup (Cohort B). Candidate predictors were screened by LASSO-penalised regression, and model performance was optimism-corrected via bootstrap resampling. Discrimination, calibration, and clinical utility were assessed by corrected AUC, calibration metrics, and decision curve analysis, with nomograms derived from the final coefficients.
RESULTS: Of 383 Cohort A patients, 106 met criteria for RMPP. Within Cohort B (n = 197), 61 children (31.0%) required treatment escalation. The RMPP model retained nine admission-day variables, including pre-admission fever duration, log-transformed CRP, LDH, D-dimer, ferritin, the neutrophil-to-lymphocyte ratio, albumin, male sex, and pleural effusion, and yielded an optimism-corrected AUC of 0.847 (95% CI: 0.810-0.886). The escalation model retained four variables (LDH, NLR, ferritin, and CRP), with a corrected AUC of 0.799 (95% CI: 0.747-0.861). Both models achieved good calibration and positive net clinical benefit across decision thresholds from 5% to 60%.
CONCLUSIONS: Our study offers a quantitative framework for stratifying children with MPP by their risk of refractory disease and treatment intensification.
METHODS: Children admitted to a single tertiary centre with a diagnosis of MPP between January 2022 and June 2025 were enrolled in a retrospective cohort study. Two penalised logistic regression models were constructed from routine admission-day clinical and laboratory variables: one targeting RMPP occurrence across the full eligible cohort (Cohort A) and one targeting corticosteroid escalation within the treated subgroup (Cohort B). Candidate predictors were screened by LASSO-penalised regression, and model performance was optimism-corrected via bootstrap resampling. Discrimination, calibration, and clinical utility were assessed by corrected AUC, calibration metrics, and decision curve analysis, with nomograms derived from the final coefficients.
RESULTS: Of 383 Cohort A patients, 106 met criteria for RMPP. Within Cohort B (n = 197), 61 children (31.0%) required treatment escalation. The RMPP model retained nine admission-day variables, including pre-admission fever duration, log-transformed CRP, LDH, D-dimer, ferritin, the neutrophil-to-lymphocyte ratio, albumin, male sex, and pleural effusion, and yielded an optimism-corrected AUC of 0.847 (95% CI: 0.810-0.886). The escalation model retained four variables (LDH, NLR, ferritin, and CRP), with a corrected AUC of 0.799 (95% CI: 0.747-0.861). Both models achieved good calibration and positive net clinical benefit across decision thresholds from 5% to 60%.
CONCLUSIONS: Our study offers a quantitative framework for stratifying children with MPP by their risk of refractory disease and treatment intensification.