Pulmonary Embolism in Children With Mycoplasma Pneumoniae Pneumonia: Assessment of Risk Factors and Current Prediction Criteria.

Purpose: Pulmonary embolism (PE) is recognized as a life-threatening complication of Mycoplasma pneumoniae pneumonia (MPP). We aimed to evaluate the risk factors of MPP with PE and examine the diagnostic accuracy of three adult-validated PE prediction criteria in children.

Methods: We retrospectively analyzed MPP patients who underwent computerized tomography pulmonary angiography (CTPA) due to suspicion of PE at the Children's Hospital of Nanjing Medical University from January 2019 to December 2023. The clinical characteristics were retrospectively recorded, and the application of three PE pretest probability strategies was assessed accordingly. We performed univariate analysis and evaluated potential predictors for PE in pediatric MPP patients via logistic regression analysis and receiver operating characteristic (ROC) curve analysis.

Results: A total of 302 MPP patients were enrolled in this study. The YEARS criteria presented better overall diagnostic accuracy than the Wells and PERC did, with a sensitivity of 96.7% and specificity of 52.6%. Multivariate logistic regression analysis revealed that days of fever before CTPA [OR = 1.159 (95% CI: 1.033-1.301), p < 0.05], d-dimer [OR = 1.000 (95% CI: 1.000-1.001), p < 0.05] and α-HBDH [OR = 1.019 (95% CI: 1.012-1.025), p < 0.05] were independent risk factors for PE in MPP children. The combined metric of those three variables had an AUC of 0.964 (95% CI: 0.932-0.995), indicating better prediction value than the separate metric.

Conclusions: Days of fever, d-dimer and α-HBDH were predictive of PE in MPP patients. Compared with the Wells and PERC rule, the YEARS criteria demonstrated relatively better overall diagnostic accuracy in MPP children complicated with PE.