Risk factors analysis of airway mucus plugs in community-acquired refractory mycoplasma pneumoniae pneumonia: a case-control study.

Background: To analyze the clinical characteristics and explore the risk factors for airway mucus plugs in children with community-acquired refractory Mycoplasma pneumoniae pneumonia (ca-RMPP).

Methods: A retrospective study was conducted on hospitalized children diagnosed with ca-RMPP from October 2023 to October 2024. The patients were divided into airway mucus plugs group and non-airway mucus plugs group based on the imaging findings under fiberoptic bronchoscopy. The differences in general data's, clinical manifestations, imaging changes, pathogens, and laboratory data's between the two groups were compared. Multivariate logistic regression was applied to analyze the independent risk factors for airway mucus plugs in children with ca-RMPP, and the Receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of risk factors.

Results: Length of hospital stay(LOS), Duration of fever, Duration of steroid treatment, Pleural effusion, Neutrophil percentage (NEU%), C-reactive protein (CRP), Procalcitonin (PCT), D-Dimer, Serum amyloid A (SAA), Lactate dehydrogenase (LDH), Ferritin, T8 lymphocyte percentage (CD8+%), Interleukin-1 β (IL-1 β), Interleukin-6 (IL-6), Interleukin-8 (IL-8) in the airway mucus plugs group were all higher than those in the non-airway mucus plugs group, While, the Lymphocyte percentage (LYM%) and CD4/CD8 ratio were lower than those in the non-airway mucus plugs group, and the differences were statistically significant ( p < 0.05). LOS ≥ 7.5 days, Duration of fever ≥ 6.5 days, CRP ≥ 13.11 mg/L, SAA ≥ 256.205 mg/L, and Ferritin ≥ 97.7ng/mL were independent risk factors.

Conclusion: LOS, Duration of fever, CRP, SAA, and Ferritin are independent risk factors for airway mucus plugs in children with ca-RMPP and the combined test can improve the diagnostic value.