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Research Article: Clinical characteristics and cytokine profiles for early prediction of severe Mycoplasma pneumoniae pneumonia in children: a prospective cohort study

Date Published: 2026-07-10

Abstract:
To investigate the clinical characteristics and cytokine profiles of children with Mycoplasma pneumoniae pneumonia (MPP) and to establish a predictive nomogram for the early recognition of severe Mycoplasma pneumoniae pneumonia (SMPP). This prospective study enrolled 445 children with MPP admitted to the Department of Pediatric Respiratory Medicine of Chengdu Women's and Children's Central Hospital between December 2022 and December 2023. Based on disease severity, patients were assigned to the mild MPP (MMPP, n =?190) and SMPP ( n =?255) groups. Clinical features and laboratory parameters were compared between the two groups.Binary Logistic regression analysis was used to identify the independent risk factors of SMPP, and a predictive nomogram was constructed based on these factors. The discrimination of the model was evaluated by the area under the receiver operating characteristic curve (AUC) and calibration curve. In addition, 42 children were randomly selected from each group using stratified random sampling, and serum cytokine levels were measured by enzyme-linked immunosorbent assay. Among the 445 children, 255 cases (57.3%) developed SMPP. Multivariate regression analysis showed that wheezing (OR=4.016, 95% CI: 1.609–10.029), shortness of breath (OR=4.717, 95% CI: 1.290–16.008), D-dimer (OR=3.032, 95% CI: 1.926–4.773), CRP (OR=1.033, 95% CI: 1.018–1.048), fever (OR=3.432, 95% CI: 1.658–7.105), and age (OR=1.114, 95% CI: 1.015–1.223) were independent risk factors for SMPP (all P <?0.05). The constructed nomogram prediction model had an AUC of 0.818 and the calibration curve indicated good predictive ability. In the cytokine sub-cohort ( n =?84), serum levels of HMGB-1, TFEB, MCP-1, MCP-2, MCP-3, MCP-4, and TNF-? were significantly higher in the SMPP group than in the MMPP group (all P <?0.05). A predictive nomogram incorporating wheezing, shortness of breath, fever, D-dimer, CRP, and age was established for early risk stratification of SMPP in hospitalized children. Multiple serum cytokines were significantly elevated in SMPP patients, and their potential clinical utility warrants further investigation in larger cohorts.

Introduction:
To investigate the clinical characteristics and cytokine profiles of children with Mycoplasma pneumoniae pneumonia (MPP) and to establish a predictive nomogram for the early recognition of severe Mycoplasma pneumoniae pneumonia (SMPP).

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