Risk factors of children with refractory mycoplasma pneumoniae pneumonia and their predictive value
Objective To analyze the risk factors of refractory mycoplasma pneumoniae pneumonia(RMPP)in chil-dren,and to explore their predictive value.Methods Totally 244 children with mycoplasma pneumoniae pneumonia(MPP)were selected.The children were divided into the RMPP group(n=65)and the general mycoplasma pneumoniae pneumonia(GMPP)group(n=197)based on whether they had RMPP.We compared the demographic information(gen-der,age),clinical manifestations,and signs(heat peak,heat duration,hypoxemia,decreased auscultatory respiratory sounds in the lungs,concomitant extrapulmonary complications,and plastic bronchitis),primary laboratory indicators within 24 hours of admission[serum circ_0054633,white blood cell count(WBC),neutrophil count(NE),neutrophil/lymphocyte ratio(NLR),platelet count(PLT),C-reactive protein(CRP),procalcitonin(PCT),interleukin 6(IL-6),lactate dehydrogenase(LDH),ferritin(FER),erythrocyte sedimentation rate(ESR),alanine aminotransferase(ALT),creatine kinase-MB(CK-MB),and D-dimer(D-D)],imaging features(atelectasis,pleural effusion).The statistically different data were included in the multivariate Logistic regression model to analyze the influencing factors of RMPP.The predictive value was analyzed by receiver operating characteristic(ROC)curve.Results There were no statistically sig-nificant differences in gender,age,heat peak,WBC,NE,PLT,CRP,PCT,ESR,ALT,or CK-MB levels between the two groups(all P>0.05).The duration of fever in the RMPP group was longer than that in the GMPP group.Hypoxemia,decreased respiratory sounds,extrapulmonary complications,plastic bronchitis,atelectasis,and the proportion of pleural effusion were all higher in the RMPP group than those in the GMPP group,and the serum circ-0054633,NLR,IL-6,LDH,FER,and D-D levels were all higher than those in the GMPP group(all P<0.05).The results of multivariate Lo-gistic regression analysis showed that fever duration(OR=1.499,95%CI:1.243-1.808),hypoxemia(OR=10.638,95%CI:2.747-41.203),concomitant extrapulmonary complications(OR=2.948,95%CI:1.174-7.404),serum circ:054633(OR=6.283,95%CI:2.729-14.465),serum IL-6(OR=1.018,95%CI:1.004-1.032),and atelectasis(OR=3.157,95%CI:1.246-8.000)were all independent risk factors for children with MPP progressing to RM-PP(all P<0.05).The ROC curve analysis results showed that the critical values of fever duration,serum circ-054633,and serum IL-6 in predicting RMPP were 9.50 d,3.12,and 25.98 pg/mL,respectively.Their sensitivities in predicting RMPP were 76.6%,80.9%,and 66.0%,with specificities of 73.0%,69.4%,and 63.8%,and the area un-der the curve of 0.768,0.802,and 0.678,respectively(all P<0.05).Conclusion The fever duration>9.50 days,hypoxemia,concurrent extrapulmonary complications,serum circ-0054633 level>3.12,serum IL-6>25.98 pg/mL,and atelectasis are risk factors for RMPP in children.Among them,heat duration,serum circ-0054633,and IL-6 have good predictive value.
万方数据
维普
