| Autor: |
Xu D; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China., Zhang AL; Department of Pediatrics, the Second Hospital of Jiaxing, Jiaxing 314001, China., Zheng JS; Department of Pediatrics, Ningbo Women and Children's Hospital, Ningbo 315012, China., Ye MW; Department of Pediatrics, Sanmen People's Hospital, Taizhou 317199, China., Li F; Department of Pediatrics, Shaoxing Second Hospital, Shaoxing 312099, China., Qian GC; Department of Pediatrics, Changxing Maternal and Child Health Care Hospital, Huzhou 313199, China., Shi HB; Department of Pediatrics, Ningbo Medical Center Lihuili Hospital, Ningbo 315048, China., Jin XH; Department of Pediatrics, Taizhou Hospital of Zhejiang Province, Taizhou 317099, China., Huang LP; Department of Pediatrics, Zhoushan Women and Children's Hospital, Zhoushan 316004, China., Mei JG; Department of Pediatrics, Cixi Maternal and Child Health Care Hospital, Ningbo 315331, China., Mei GH; Department of Pediatrics, Quzhou Maternal and Child Health Care Hospital, Quzhou 324003, China., Xu Z; Department of Pediatrics, Huzhou Central Hospital, Huzhou 313099, China., Fu H; Department of Pediatrics, Shengsi People's Hospital, Zhoushan 202450, China., Lin JJ; Department of Pediatrics, Lishui City People's Hospital, Lishui 323050, China., Ye HZ; Department of Pediatrics, the First People's Hospital of Huzhou, Huzhou 313099, China., Zheng Y; Department of Pediatrics, People's Hospital of Quzhou, Quzhou 324002, China., Hua LL; Department of Pediatrics, Ningbo Women and Children's Hospital, Ningbo 315012, China., Yang M; Department of Pediatrics, Sanmen People's Hospital, Taizhou 317199, China., Tong JM; Department of Pediatrics, Changxing Maternal and Child Health Care Hospital, Huzhou 313199, China., Chen LL; Department of Pediatrics, Taizhou Hospital of Zhejiang Province, Taizhou 317099, China., Zhang YY; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China., Yang DH; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China., Zhou YL; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China., Li HW; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China., Lan YL; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China., Xu YL; Department of Pediatrics, Zhoushan Women and Children's Hospital, Zhoushan 316004, China., Feng JY; Department of Pediatrics, Cixi Maternal and Child Health Care Hospital, Ningbo 315331, China., Chen X; Department of Pediatrics, Huzhou Central Hospital, Huzhou 313099, China., Gong M; Department of Pediatrics, People's Hospital of Quzhou, Quzhou 324002, China., Chen ZM; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China., Wang YS; Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China. |
| Abstrakt: |
Objective: To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods: The prospective multicenter study was conducted in Zhejiang, China from May 1 st , 2019 to January 31 st , 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results: A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P <0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P <0.01). Conclusion: In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP. |
