Department of Pharmacy, Hejiang People's Hospital, Luzhou City, Sichuan Province, China.
Department of Clinical Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou City, Sichuan Province, China.
Medicine (Baltimore). 2024 Aug 23;103(34):e39375. doi: 10.1097/MD.0000000000039375.
To determine the clinical indicators predictive of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and develop a robust predictive model to aid in early identification and management. A retrospective cohort study was conducted on 338 children diagnosed with RMPP out of a total of 1500 cases of Mycoplasma pneumoniae at a single tertiary hospital from May 2021 to November 2023. Clinical and demographic data analyzed included age, gender, parents' educational level, household income, body mass index, allergic constitution, and laboratory findings such as white blood cell count, neutrophil and lymphocyte counts, platelet count, and levels of C-reactive protein (CRP), D-dimer, and procalcitonin. Univariate and multivariate logistic regression analyses were performed to identify significant predictors of RMPP, and a predictive model was developed. Among the RMPP cohort, 52.4% were female, with a mean age of 6.07 ± 2.78 years. Multivariate analysis identified several significant predictors of poor prognosis, including higher body mass index, longer duration of fever, elevated white blood cell count, neutrophil count, C-reactive protein levels, and increased neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. The model demonstrated outstanding diagnostic performance, with an area under the receiver operating characteristic curve of 0.963 (95% confidence interval: 0.946-0.981). Our study identifies key clinical indicators with significant diagnostic accuracy for predicting RMPP in children. The predictive model established offers a valuable tool for clinicians, potentially improving RMPP outcomes through timely intervention.
为了确定儿童难治性肺炎支原体肺炎（RMPP）的临床预测指标，并开发一种强大的预测模型以帮助早期识别和管理，我们进行了一项回顾性队列研究。该研究在一家三级医院，对 2021 年 5 月至 2023 年 11 月期间，总共 1500 例肺炎支原体感染的患儿中，诊断为 RMPP 的 338 例患儿进行了研究。分析的临床和人口统计学数据包括年龄、性别、父母的教育程度、家庭收入、体重指数、过敏体质，以及白细胞计数、中性粒细胞和淋巴细胞计数、血小板计数以及 C 反应蛋白（CRP）、D-二聚体和降钙素原水平等实验室检查结果。进行单变量和多变量逻辑回归分析，以确定 RMPP 的显著预测因素，并建立预测模型。在 RMPP 队列中，52.4%为女性，平均年龄为 6.07±2.78 岁。多变量分析确定了几个预后不良的显著预测因素，包括较高的体重指数、较长的发热持续时间、较高的白细胞计数、中性粒细胞计数、CRP 水平，以及升高的中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值。该模型表现出出色的诊断性能，其受试者工作特征曲线下面积为 0.963（95%置信区间：0.946-0.981）。我们的研究确定了一些具有显著诊断准确性的关键临床指标，可用于预测儿童 RMPP。建立的预测模型为临床医生提供了有价值的工具，可能通过及时干预来改善 RMPP 结局。
