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[A multicenter prospective study on early identification of refractory Mycoplasma pneumoniae pneumonia in children].

[A multicenter prospective study on early identification of refractory Mycoplasma pneumoniae pneumonia in children].

Authors :
Xu D
Zhang AL
Zheng JS
Ye MW
Li F
Qian GC
Shi HB
Jin XH
Huang LP
Mei JG
Mei GH
Xu Z
Fu H
Lin JJ
Ye HZ
Zheng Y
Hua LL
Yang M
Tong JM
Chen LL
Zhang YY
Yang DH
Zhou YL
Li HW
Lan YL
Xu YL
Feng JY
Chen X
Gong M
Chen ZM
Wang YS
Source :
Zhonghua er ke za zhi = Chinese journal of pediatrics [Zhonghua Er Ke Za Zhi] 2024 Mar 25; Vol. 62 (4), pp. 317-322.
Publication Year :
2024

Abstract

Objective: To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods: The prospective multicenter study was conducted in Zhejiang, China from May 1 <superscript>st</superscript> , 2019 to January 31 <superscript>st</superscript> , 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results: A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P <0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P <0.01). Conclusion: In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Details

Language :
Chinese
ISSN :
0578-1310
Volume :
62
Issue :
4
Database :
MEDLINE
Journal :
Zhonghua er ke za zhi = Chinese journal of pediatrics
Publication Type :
Academic Journal
Accession number :
38527501
Full Text :
https://doi.org/10.3760/cma.j.cn112140-20231121-00383