A Web-Based Dynamic Nomogram for Predicting Refractory Mycoplasma pneumoniae Pneumonia in Children

Summary

The present study comprehensively evaluated clinical manifestations, laboratory indices, and imaging features in children with MPP to identify independent risk factors for RMPP and to establish an online dynamic nomogram for early prediction.

Abstract

Refractory Mycoplasma pneumoniae pneumonia (RMPP) in children is associated with stronger inflammatory responses, more complex management, and a higher risk of pulmonary complications. Early identification of high-risk children may support timely treatment adjustment. This retrospective study included 500 hospitalized children with Mycoplasma pneumoniae pneumonia from November 2022 to November 2023. The cohort was randomly divided into a training set (n = 375) and a validation set (n = 125). Univariable and multivariable logistic regression analyses identified six independent predictors of RMPP: fever duration before admission, peak body temperature, lactate dehydrogenase level, sputum plugs or pleural effusion, lung consolidation, and hypoxemia. A web-based dynamic nomogram was constructed using these variables. The model showed good discrimination, with an area under the receiver operating characteristic curve/C-index of 0.840 (95% CI, 0.785–0.892) in the training set and 0.831 (95% CI, 0.743–0.906) in the validation set. Calibration curves showed good agreement between predicted and observed risks, and decision curve analysis suggested clinical net benefit across most threshold probabilities. Children with prolonged fever, high peak temperature, elevated lactate dehydrogenase, hypoxemia, and CT evidence of lung consolidation or sputum plugs/pleural effusion should be considered at increased risk of RMPP and may require closer monitoring and timely treatment adjustment.

Introduction

Mycoplasma pneumoniae (MP) is a major pathogen of community-acquired pneumonia in children, especially in preschool-and school-aged populations¹. Mycoplasma pneumoniae pneumonia (MPP) accounts for a considerable proportion of pediatric pneumonia, and its incidence has increased in recent years². Most children have a favorable course after appropriate treatment; however, some develop persistent fever, worsening respiratory symptoms, or progressive radiographic abnormalities after at least 7 days of standard macrolide therapy, a phenomenon potentially attributable to macrolide resistance and/or delayed tr....

Protocol

This study was approved by the Ethics Committee of Jinhua Women's and Children's Hospital (No. 2024KY099). Informed consent was obtained from the children's legal guardians.

Patient data

This retrospective study included children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized at the Children’s Hospital Affiliated to Jinhua Women and Children’s Hospital from November 2022 to November 2023. MPP was diagnosed based on respiratory symptoms, chest imaging findings, and positive Mycoplasma pneumoniae DNA or RNA testing. General MPP (GMPP) refers to child....

Results

Clinical data were collected retrospectively and handled in accordance with institutional confidentiality requirements.

Study population

A total of 500 eligible children were included, including 272 boys and 228 girls. The training cohort included 375 children, of whom 286 had GMPP (general MPP), and 89 had RMPP. The validation cohort included 125 children, of whom 85 had GMPP, and 40 had RMPP. The training and validation cohorts were comparable in .......

Discussion

RMPP is associated with sustained inflammation, poor response to standard macrolide therapy, and increased risk of pulmonary and extrapulmonary complications. Early identification of high-risk children is therefore important for timely treatment adjustment. In this study, fever duration before admission, peak body temperature, LDH, sputum plugs or pleural effusion, lung consolidation, and hypoxemia were independently associated with RMPP. A web-based dynamic nomogram based on these variables showed stable discrimination,.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
R software version 4.1.2	R Foundation for Statistical Computing, Vienna, Austria	http://www.r-project.org
Revolution 256-slice CT scanner	GE Healthcare, United States	www.gehealthcare.com