Refractory Mycoplasma Pneumonia in Children: A Systematic Review and Meta-analysis of Laboratory Features and Predictors

Abstract

Background. Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia (CAP) in children. M. pneumoniae infection is usually regarded as a self-limiting disease, but in some special cases, it can also develop into refractory Mycoplasma pneumoniae pneumonia (RMPP). The aim of this study is to analyze the clinical characteristics of CRP (C-reactive protein), LDH (lactate dehydrogenase), ESR (erythrocyte sedimentation rate), D-dimer, neutrophils (%), lymphocytes (%), and lung consolidation in RMPP and explore their prediction results in the early stage of RMPP, which is important for early treatment. Methods. This systematic search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wangfang, and Cqvip, and the date was set until February 23, 2021. For the continuous variables, mean difference (MD) with 95% CI was adopted to evaluate CRP, LDH, ESR, D-dimer, neutrophils (%), lymphocytes (%), and the correlation between lung consolidation and RMPP. Results. 20 studies including 5289 patients were included in the analysis, and the results showed that the CRP of the RMPP group (MD (95% CI): 22.29 (12.20, 32.38), P < 0.001 ), LDH (MD (95% CI): 145.13 (78.62, 211.64), P < 0.001 ), neutrophils (%) (MD (95% CI): 7.27 (0.31, 14.23), P = 0.04 ), and D-dimer (MD (95% CI): 1.79 (-1.17, 4.74), P = 0.24 ) was higher than that of the NRMPP group; the risk of lung consolidation in the RMPP group (OR (95% CI): 14.29 (4.52, 45.12), P < 0.001 ) was higher than that in the NRMPP group, and there was no difference in ESR (MD (95% CI): 8.11 (-1.34, 17.56), P = 0.09 ) and lymphocytes (%) (MD (95% CI): -6.27 (-12.81, 0.27), P = 0.06 ) between the two groups. Conclusion. So, the available evidence indicates that CRP, LDH, neutrophils (%), D-dimer, and lung consolidation are predictive factors for RMPP.

Epidemic characteristics of Mycoplasma pneumoniae infection: a retrospective analysis of a single center in Suzhou from 2014 to 2020

“…Early identification of SMPP in young MPP patients is of urgent clinical value. Studies have shown that fever over 10 days, young children, higher D-dimer level, lung consolidation, massive pleural effusion, necrotizing pneumonia, CRP >60 mg/L, LDH >410 IU/L, and extrapulmonary complications can be used as predictors of SMPP (33)(34)(35), which is consistent with our results.…”

Correlation of DNA load, genotyping, and clinical phenotype of Mycoplasma pneumoniae infection in children

“…It is present in small amounts in an organism's normal state, and its level increases linearly when infected ( 27 ). Notably, some studies have suggested that both inflammatory mediators are closely associated with MPP and are critical biomarkers for measuring MP infection status and predicting the occurrence of severe and refractory MPP ( 28 , 29 ). Serum CRP and PCT levels are lower after MP infection than after bacterial infection; however, they help predict severe MPP ( 28 ).…”

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

“…Prior to our diagnostic meta-analysis, a risk factor-related meta-analysis by Huang discussed CRP, LDH, D dimer, etc. as risk factors for RMPP, but limited to one qualitative and only seven studies on LDH, with possible search bias ( 45 ). Therefore, we conducted a comprehensive search, we conducted a meta-analysis of the diagnostic efficacy of LDH on RMPP, and performed a subgroup analysis to classify and discuss different LDH thresholds, age, case sources, etc., hoping to better guide clinical practice.…”