Prediction model for prolonged fever in patients with Mycoplasma pneumoniae pneumonia: a retrospective study of 716 pediatric patients

Abstract

Objective To identify patients with Mycoplasma pneumoniae pneumonia (MPP) with a risk of prolonged fever while on macrolides. Methods A retrospective study was performed with 716 children admitted for MPP. Refractory MPP (RMPP-3) was defined as fever persisting for > 72 h without improvement in clinical and radiologic findings after macrolide antibiotics (RMPP-3) or when fever persisted for > 120 h (RMPP-5) without improvement in clinical and radiologic findings. Radiological data, laboratory data, and fever profiles were compared between the RMPP and non-RMPP groups. Fever profiles included the highest temperature, lowest temperature, and frequency of fever. Prediction models for RMPP were created using the logistic regression method and deep neural network. Their predictive values were compared using receiver operating characteristic curves. Results Overall, 716 patients were randomly divided into two groups: training and test cohorts for both RMPP-3 and RMPP-5. For the prediction of RMPP-3, a conventional logistic model with radiologic grouping showed increased sensitivity (63.3%) than the model using laboratory values. Adding laboratory values in the prediction model using radiologic grouping did not contribute to a meaningful increase in sensitivity (64.6%). For the prediction of RMPP-5, laboratory values or radiologic grouping showed lower sensitivities ranging from 12.9 to 16.1%. However, prediction models using predefined fever profiles showed significantly increased sensitivity for predicting RMPP-5, and neural network models using 12 sequential fever data showed a greatly increased sensitivity (64.5%). Conclusion RMPP-5 could not be effectively predicted using initial laboratory and radiologic data, which were previously reported to be predictive. Further studies using advanced mathematical models, based on large-sized easily accessible clinical data, are anticipated for predicting RMPP.

Diagnostic value of serum LDH in children with refractory Mycoplasma pneumoniae pneumoniae: A systematic review and meta-analysis

“…A total of 29 articles were included, including 702,2 subjects, of which 227,9 children were diagnosed RMPP and 474,3 children were diagnosed general Mycoplasma pneumoniae pneumonia (GMPP). 2 studies ( 14 , 15 ) used diagnostic criterion 1 as the “gold standard” for diagnosing RMPP, and the rest of the studies used diagnostic criterion 2 as the “gold standard” for diagnosing RMPP. The included studies were mainly from Asian countries, of which 1 study ( 16 ) was from Japan, 3 studies ( 14 , 15 , 17 ) were from South Korea, and the rest were from China.…”

“…2 studies ( 14 , 15 ) used diagnostic criterion 1 as the “gold standard” for diagnosing RMPP, and the rest of the studies used diagnostic criterion 2 as the “gold standard” for diagnosing RMPP. The included studies were mainly from Asian countries, of which 1 study ( 16 ) was from Japan, 3 studies ( 14 , 15 , 17 ) were from South Korea, and the rest were from China. The sample size of each group ranged from 20 to 703 cases.…”

“…2 studies ( 7 , 18 ) were clearly indicated as cohort studies with low risk of bias in patient selection, and the remaining studies were case-control studies, so there may be high risk of bias in patient selection. 2 studies ( 14 , 17 ) were defined as uncertain risk in index test because they did not clearly state the threshold, and the remaining studies were defined as high risk of bias in index test because their threshold was not determined in advance. All studies were defined as low risk of bias with respect to the reference standard because each study clearly indicated the gold standard for diagnosis and the interpretation of the results was performed without knowledge of the results of the trial to be evaluated.…”

“…All studies were defined as low risk of bias with respect to the reference standard because each study clearly indicated the gold standard for diagnosis and the interpretation of the results was performed without knowledge of the results of the trial to be evaluated. 7 studies ( 14 , 17 , 20 , 28 , 36 – 38 ) did not specify the timing of LDH detection, so the flow and timing part was defined as uncertain risk, and the remaining studies were at low risk of bias. Overall, the quality of the included literature can be rated as moderate to high, and the results of all studies are generally credible.…”

A Lung Ultrasound-Based Nomogram for the Prediction of Refractory Mycoplasma pneumoniae Pneumonia in Hospitalized Children

“…Pulmonary imaging in RMPP usually shows extensive consolidation or atelectasis in one or more lobes and pleural effusion. 15 In practical clinical work, imaging evaluation primarily relies on CXR or chest CT. 28 CXR is fast, inexpensive, and widely used in outpatient, emergency, and primary ward hospitals. However, CXR lacks accuracy and reliability in diagnosing pneumonia and exposes children to ionizing radiation; furthermore, the interobserver agreement is low.…”