Analysis of risk factors for refractory Mycoplasma pneumoniae pneumonia in children

doi:10.3969/j.issn.1004-583X.2024.01.007

Abstract

Abstract:

Objective To analyze risk factors for refractory $M y c o p l a s m a p n e u m o n i a e$ pneumonia (RMPP) in children. Methods A total of 67 children with RMPP who were admitted in the Department of Paediatrics, Luoyuan County Hospital from January 2020 to September 2023 were enrolled in the case group. During the same period, 134 children with common $M y c o p l a s m a p n e u m o n i a e$ pneumonia and complete clinical data were selected in the control group. Children in both groups were initially treated with macrolide antibiotics. Univariate and multivariate logistic regression analyses were used to analyze the risk factors for RMPP in children. The predictive potentials of risk factors for RMPP in children were assessed by plotting the receiver operating characteristic (ROC) curves. Results Decreased albumin, decreased platelet count, heat peak≥40 ℃, lactate dehydrogenase≥500 U/L, and lobar pneumonia changes on pulmonary imaging were risk factors for RMPP in children. The area under the curve (AUC) and cut-off value of risk factors were as follows: albumin<40 g/L (AUC=0.765, 95% $C I$ =0.803-0.901), lactate dehydrogenase≥500 U/L (AUC=0.753, 95% $C I$ =0.772-0.877), platelet count<120×10⁹/L (AUC=0.821, 95% $C I$ :0.761-0.868), heat peak≥40 ℃ (AUC=0.750, 95% $C I$ : 0.685-0.807), and lobar pneumonia changes on pulmonary imaging (AUC=0.541, 95% $C I$ : 0.469-0.611). Conclusion RMPP should be alerted in children with albumin<40 g/L, platelet count<120×10⁹/L, heat peak≥40 ℃, lactate dehydrogenase≥500 U/L, and lobar pneumonia changes on pulmonary imaging.

Key words: pneumonia, mycoplasma, child, risk factors

CLC Number:

R563.1

Yu Zeyu, Lin Xi, Chen Zhanghua, Yang Wei, Chen Zhimin, Zhang Hai. Analysis of risk factors for refractory Mycoplasma pneumoniae pneumonia in children[J]. Clinical Focus, 2024, 39(1): 43-46.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.01.007

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I1/43

Figures/Tables 5

Tab.1 Comparison of general information between two groups

组别	例数	年龄 (岁)	女性 [例(%)]	肝功能损害 [例(%)]	皮疹 [例(%)]	肺部影像学进行性加重 [例(%)]	发热持续时间 ≥7 d[例(%)]	发热持续时间 ≥10 d[例(%)]	发热峰值≥39 ℃ [例(%)]	发热峰值≥40 ℃ [例(%)]
病例组	67	2.10(0.8,10.0)	23(34.3)	10(14.9)	8(11.9)	5(7.5)	67(100.0)	28(41.8)	67(100.0)	50(74.6)
对照组	134	2.35(0.75,10.0)	50(37.3)	22(16.4)	18(13.4)	0	60(44.8)	23(17.2)	85(63.4)	20(14.9)
统计值		$Z$ =-1.816	χ²=0.172	χ²=0.172	χ²=0.088	χ²=7.409	χ²=58.559	χ²=14.306	χ²=32.398	χ²=70.142
$P$ 值		0.057	0.678	0.668	0.356	0.005	0.000	0.000	0.000	0.000

Tab.1 Comparison of general information between two groups

组别	例数	年龄 (岁)	女性 [例(%)]	肝功能损害 [例(%)]	皮疹 [例(%)]	肺部影像学进行性加重 [例(%)]	发热持续时间 ≥7 d[例(%)]	发热持续时间 ≥10 d[例(%)]	发热峰值≥39 ℃ [例(%)]	发热峰值≥40 ℃ [例(%)]
病例组	67	2.10(0.8,10.0)	23(34.3)	10(14.9)	8(11.9)	5(7.5)	67(100.0)	28(41.8)	67(100.0)	50(74.6)
对照组	134	2.35(0.75,10.0)	50(37.3)	22(16.4)	18(13.4)	0	60(44.8)	23(17.2)	85(63.4)	20(14.9)
统计值		$Z$ =-1.816	χ²=0.172	χ²=0.172	χ²=0.088	χ²=7.409	χ²=58.559	χ²=14.306	χ²=32.398	χ²=70.142
$P$ 值		0.057	0.678	0.668	0.356	0.005	0.000	0.000	0.000	0.000

Tab.2 Comparison of clinical data between two groups

组别	例数		肺部影像学呈大叶性肺炎 [例(%)]		异常心电图 [例(%)]		异常尿常规 (血尿、蛋白尿) [例(%)]		白细胞计数 (×10⁹/L)		中性粒细胞计数(×10⁹/L)		血小板计数 (×10⁹/L)
病例组	67		64(95.5)		3(4.5)		10(14.9)		17.54(6.58,32.44)		9.56(0.85,25.67)		94.51(62.47,130.69)
对照组	134		52(38.8)		6(4.5)		18(13.4)		13.69(4.85,20.42)		7.85(0.76,17.44)		250.35(118.32,480.87)
统计值			χ²=58.870		χ²=0. 130		χ²=0.080		$Z$ =-6.520		$Z$ =-3.540		$Z$ =-7.652
$P$ 值			0.000		0.718		0. 773		0.000		0.000		0.000
组别	血清铁蛋白 (μg/L)			D-二聚体 (mg/L)				C反应蛋白 (mg/L)		乳酸脱氢酶 ( U/L)		谷丙转氨酶 ( U/L)		白蛋白 (g/L)
病例组	428.26(108.47,554.62)			3.14(0.42,6.54)				52.28(0.50,185.25)		408.58(190.55,1439)		48.25(15.32,205.86)		36.85(26.53,47.27)
对照组	307.85(80.67,486.43)			2.33(0.38,4.22)				16.58(0.50,80.54)		306.15(154.63,608.21)		18.54(6.42,68.92)		41.85(36.0,43.24)
统计值	$Z$ =-6.420			$Z$ =-3.690				$Z$ =-5.81		$Z$ =-3.548		$Z$ =-6.542		$Z$ =-7.358
$P$ 值	0.000			0.000				0.000		0.018		0.000		0.000
组别		血清钠(mmol/L)				血清钙(mmol/L)			总胆红素(μmol/L)		甘油三酯(mmol/L)		肌酸激酶同工酶( U/L)
病例组		135.83±2.47				2.48±0.21			7.28(2.18,36.22)		1.07(0.17,3.43)		30.70(6.69,144.69)
对照组		136.34±2.27				2.44±0.17			6.61(2.01,25.29)		1.13(0.15,8.53)		30.38(0.20,99.69)
统计值		$t$ =1.417				$t$ =1.353			$Z$ =-1.647		$Z$ =-1.603		$Z$ =-1.569
$P$ 值		0.150				0.165			0.096		0.101		0.105

Tab.2 Comparison of clinical data between two groups

组别	例数		肺部影像学呈大叶性肺炎 [例(%)]		异常心电图 [例(%)]		异常尿常规 (血尿、蛋白尿) [例(%)]		白细胞计数 (×10⁹/L)		中性粒细胞计数(×10⁹/L)		血小板计数 (×10⁹/L)
病例组	67		64(95.5)		3(4.5)		10(14.9)		17.54(6.58,32.44)		9.56(0.85,25.67)		94.51(62.47,130.69)
对照组	134		52(38.8)		6(4.5)		18(13.4)		13.69(4.85,20.42)		7.85(0.76,17.44)		250.35(118.32,480.87)
统计值			χ²=58.870		χ²=0. 130		χ²=0.080		$Z$ =-6.520		$Z$ =-3.540		$Z$ =-7.652
$P$ 值			0.000		0.718		0. 773		0.000		0.000		0.000
组别	血清铁蛋白 (μg/L)			D-二聚体 (mg/L)				C反应蛋白 (mg/L)		乳酸脱氢酶 ( U/L)		谷丙转氨酶 ( U/L)		白蛋白 (g/L)
病例组	428.26(108.47,554.62)			3.14(0.42,6.54)				52.28(0.50,185.25)		408.58(190.55,1439)		48.25(15.32,205.86)		36.85(26.53,47.27)
对照组	307.85(80.67,486.43)			2.33(0.38,4.22)				16.58(0.50,80.54)		306.15(154.63,608.21)		18.54(6.42,68.92)		41.85(36.0,43.24)
统计值	$Z$ =-6.420			$Z$ =-3.690				$Z$ =-5.81		$Z$ =-3.548		$Z$ =-6.542		$Z$ =-7.358
$P$ 值	0.000			0.000				0.000		0.018		0.000		0.000
组别		血清钠(mmol/L)				血清钙(mmol/L)			总胆红素(μmol/L)		甘油三酯(mmol/L)		肌酸激酶同工酶( U/L)
病例组		135.83±2.47				2.48±0.21			7.28(2.18,36.22)		1.07(0.17,3.43)		30.70(6.69,144.69)
对照组		136.34±2.27				2.44±0.17			6.61(2.01,25.29)		1.13(0.15,8.53)		30.38(0.20,99.69)
统计值		$t$ =1.417				$t$ =1.353			$Z$ =-1.647		$Z$ =-1.603		$Z$ =-1.569
$P$ 值		0.150				0.165			0.096		0.101		0.105

Tab.3 Logistic regression analysis of risk factors for RMPP

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
白蛋白下降	-0.125	0.041	7.326	0.008	0.765	0.723	0.951
乳酸脱氢酶≥500 U/L	0.009	0.003	5.654	0.015	1.001	1.001	1.018
热峰≥40 ℃	2.953	1.032	8.095	0.003	19.364	2.507	149.071
影像学呈大叶性肺炎	3.380	1.213	7.663	0.005	29.673	2.685	326.841
血小板计数下降	-0.408	0.130	8.804	0.002	0.646	0.487	0.856

Tab.3 Logistic regression analysis of risk factors for RMPP

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
白蛋白下降	-0.125	0.041	7.326	0.008	0.765	0.723	0.951
乳酸脱氢酶≥500 U/L	0.009	0.003	5.654	0.015	1.001	1.001	1.018
热峰≥40 ℃	2.953	1.032	8.095	0.003	19.364	2.507	149.071
影像学呈大叶性肺炎	3.380	1.213	7.663	0.005	29.673	2.685	326.841
血小板计数下降	-0.408	0.130	8.804	0.002	0.646	0.487	0.856

Tab.4 Predictive potentials of risk factors for RMPP

变量	曲线下面积	标准误	界值	$P$ 值	95% $C I$		敏感度 (%)	特异度 (%)	约登指数
变量	曲线下面积	标准误	界值	$P$ 值	下限	上限	敏感度 (%)	特异度 (%)	约登指数
白蛋白下降	0.765	0.028	<40 g/L	<0.01	0.803	0.901	67.64	94.13	0.620
乳酸脱氢酶≥500 U/L	0.753	0.032	≥500 U/L	<0.01	0.772	0.877	73.42	86.01	0.590
热峰≥40 ℃	0.750	0.030	-	<0.01	0.685	0.807	79.31	72.38	0.520
血小板计数下降	0.821	0.030	<120×10⁹/L	<0.01	0.761	0.868	79.32	75.63	0.550
影像学呈大叶性肺炎	0.541	0.021	-	0.019	0.469	0.611	13.13	97.15	0.100

Tab.4 Predictive potentials of risk factors for RMPP

变量	曲线下面积	标准误	界值	$P$ 值	95% $C I$		敏感度 (%)	特异度 (%)	约登指数
变量	曲线下面积	标准误	界值	$P$ 值	下限	上限	敏感度 (%)	特异度 (%)	约登指数
白蛋白下降	0.765	0.028	<40 g/L	<0.01	0.803	0.901	67.64	94.13	0.620
乳酸脱氢酶≥500 U/L	0.753	0.032	≥500 U/L	<0.01	0.772	0.877	73.42	86.01	0.590
热峰≥40 ℃	0.750	0.030	-	<0.01	0.685	0.807	79.31	72.38	0.520
血小板计数下降	0.821	0.030	<120×10⁹/L	<0.01	0.761	0.868	79.32	75.63	0.550
影像学呈大叶性肺炎	0.541	0.021	-	0.019	0.469	0.611	13.13	97.15	0.100

Fig.1 ROC curve of risk factors for predicting RMPP

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