Early Discrimination of Refractory Mycoplasma Pneumoniae Pneumonia in Children: A Multicenter Prospective Study in Zhejiang, China

Abstract

Objective: To explore potential predictors of RMPP in early stage.Study design: The prospective study, multicenter study was conducted in Zhejiang, China from May 1st, 2019 to January 31st, 2020. Children aged 29 days to 14 years old, with fever time during 48 to 120 hours were included. A total of 1428 children completed the study. A questionnaire was designed to collect patients’ information. Pharyngeal swab samples were collected. M. pneumoniae DNA in pharyngeal swab specimens were detected. Whether the patients develop to RMPP were assessed. Logistic regression analyses were used to examine associations between clinical data and RMPP.Results: The ages of the patients ranged from 34 days to 13.9 years with a median 4.3 years. The positive rate of M. pneumoniae -DNA was 37.4% (534/1428), and 446 cases were Mycoplasma pneumoniae pneumonia (MPP). In MPP patients, 55 cases were RMPP (12.3%), others were general MPP (GMPP) patients (n=391, 87.7%). Only the peak body temperature before the first visit and LDH level in RMPP patients were higher than that in GMPP [39.6 (39.1-40.0) °C vs. 39.2 (38.9-39.7) °C, p=0.003, and 332.5 (278.8-392.1) U/L vs. 310.5 (259.0-358.8) U/L, p=0.024]. Logistic regression also only included the above two parameters in the prediction probability. The area under ROC curve of the prediction probability π of RMPP was 0.682 (95% CI, 0.593-0.771), P<0.01. The cut-off value was 0.12. Sensitivity and specificity of the prediction probability π in cut-off value was 0.64 and 0.70, respectively.Conclusions: AND RELEVANCE A prediction probability, calculating from the peak body temperature before the first visit and LDH level for early identifying RMPP from other MPP within 2-5 days of fever duration, with a cut-off value of 0.12 may be helpful in clinical practice.