A clinical study of preditors of multiple bronchoscopic lavage therapy in children with plastic bronchitis due to severe Mycoplasma pneumoniae pneumonia
Objective To analyze the clinical characteristics of children with severe Mycoplasma pneumoniae pneumonia(SMPP)induced plastic bronchitis(PB)requiring multiple bronchoscopic lavage treatments.Methods The clinical data related to children with SMPP causing PB admitted to the Department of Pediatric Respiratory Medicine,Shengjing Hospital of China Medical University,from January 2017 to December 2019 was retrospectively analyzed.According to the number of bronchoscopic lavage treatment,the children were divided into the multiple group(≥2 times)and the single group,and the differences between the two groups of children in terms of clinical manifestations,laboratory tests,and imaging characteristics were compared,and the indicators with statistically significant differences between the two groups were subjected to multifactorial Logistic regression analysis to draw the receiver operating characteristic curve of the subjects.Analysis of predictors of the need for multiple bronchoscopic lavage treatment for PB due to SMPP in children was conducted.Results A total of 68 children with PB due to SMPP were collected,including 24 cases in the multiple group and 44 cases in the single group.Compared with the single group,the multiple group had a longer fever duration[(14.46±3.68)d vs.(11.14±2.64)d,t=4.302],longer hospital stay[(16.83±5.40)d vs.(11.00±3.19)d,t=4.848],a higher proportion of peripheral blood neutrophils[(74.67±11.06)％vs.(63.02±14.46)％,t=3.431],increased IL-6 levels[69.98(24.79,119.90)pg/mol vs.31.10(17.29,54.86)pg/mol,Z=-2.336],elevated lactate dehydrogenase levels[(683.08±248.39)U/L vs.(495.86±170.88)U/L,t=3.292],and increased D-dimer[2 168.50(1 244.25,3 227.75)μg/L vs.915.50(479.00,2 017.75)μg/L,Z=-3.536],and the differences were statistically significant(all P＜0.05).Logistic regression analysis revealed that three independent factors,neutrophil percentage,lactate dehydrogenase and D-dimer,could be valuable predictors of the need for multiple bronchoscopic lavage treatments for PB due to SMPP,with critical values of 74.35％,629.5 U/L and 963 μg/L,respectively.Conclusion PB due to SMPP in children is severe,and treated with aggressive anti-infective and symptomatic supportive treatment such as bronchoscopic lavage,most of them have a good prognosis.In children with PB due to SMPP with neutrophil ratio＞74.35％,lactate dehydrogenase＞629.5 U/L and D-dimer＞963 µg/L,it should be noted that multiple bronchoscopic lavage treatments may be required.
Severe Mycoplasma pneumoniae pneumoniaPlastic bronchitisBronchoscopy
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