Clinical Prediction of Necrotizing Pneumonia in Children With Mycoplasma pneumoniae: A Model Based on Early Response to Therapy.

IF 2.1 4区医学 Q3 RESPIRATORY SYSTEM

Canadian respiratory journal Pub Date : 2026-01-01 DOI:10.1155/carj/3623045

Jia Feng Zheng, Meng Yao Zhang, Han Quan Dong, Bo Wang, Yong Sheng Xu

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引用次数: 0

Abstract

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.

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肺炎支原体患儿坏死性肺炎的临床预测：基于早期治疗反应的模型

目的：本研究旨在确定对初始治疗无效的肺炎支原体肺炎（MPP）患儿进展为坏死性肺炎（NP）的预测因素，并建立预测模型以支持早期临床决策。方法：回顾性分析天津市儿童医院2021年1月至2025年1月收治的大环内酯无反应肺炎支原体肺炎（MUMPP）患儿的临床和实验室资料。MUMPP定义为标准化静脉大环内酯治疗≥72小时后持续发热（≥38.5°C，持续≥4小时/天）。将患者分为观察组（n = 106，发生NP者）和对照组（n = 130，未发生NP者）。通过多变量逻辑回归识别NP的独立预测因子，并将其纳入nomogram。采用ROC分析、校正图和决策曲线分析评估模型的性能。结果：在多变量分析中，白细胞（WBC）计数增加（OR = 2.484, 95% CI: 1.406-4.613）、发热持续时间延长（OR = 1.618, 95% CI: 1.217-2.193）、胸腔积液（OR = 3.955, 95% CI: 1.664-10.00）和c反应蛋白（CRP）升高（OR = 2.152, 95% CI: 1.547-3.074）与初始治疗失败后MPP患儿NP独立相关。校正曲线显示推导队列（p = 0.588）和验证队列（p = 0.424）的预测风险和观察风险之间的一致性非常高。该模型具有良好的判别性，衍生队列的AUC为0.848 (95% CI: 0.789-0.908)，验证队列的AUC为0.889 （95% CI: 0.815-0.963）。决策曲线分析表明，净临床效益跨越相关阈值概率。结论：在MUMPP患儿中，较高的白细胞计数、持续发热、胸腔积液和较高的CRP是NP风险增加的标志。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian respiratory journal 医学-呼吸系统

CiteScore

4.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.