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Research Article: Prediction models for refractory Mycoplasma pneumoniae pneumonia and corticosteroid treatment escalation in hospitalized children: a retrospective cohort study

Date Published: 2026-09-21

Abstract:
Mycoplasma pneumoniae carries a clinically important risk of a refractory course or the need for intensified corticosteroid therapy. No admission-day prediction tool has been validated to identify children at risk for either outcome. Children admitted to a single tertiary centre with a diagnosis of MPP between January 2022 and June 2025 were enrolled in a retrospective cohort study. Two penalised logistic regression models were constructed from routine admission-day clinical and laboratory variables: one targeting RMPP occurrence across the full eligible cohort (Cohort A) and one targeting corticosteroid escalation within the treated subgroup (Cohort B). Candidate predictors were screened by LASSO-penalised regression, and model performance was optimism-corrected via bootstrap resampling. Discrimination, calibration, and clinical utility were assessed by corrected AUC, calibration metrics, and decision curve analysis, with nomograms derived from the final coefficients. Of 383 Cohort A patients, 106 met criteria for RMPP. Within Cohort B ( n =?197), 61 children (31.0%) required treatment escalation. The RMPP model retained nine admission-day variables, including pre-admission fever duration, log-transformed CRP, LDH, D-dimer, ferritin, the neutrophil-to-lymphocyte ratio, albumin, male sex, and pleural effusion, and yielded an optimism-corrected AUC of 0.847 (95% CI: 0.810–0.886). The escalation model retained four variables (LDH, NLR, ferritin, and CRP), with a corrected AUC of 0.799 (95% CI: 0.747–0.861). Both models achieved good calibration and positive net clinical benefit across decision thresholds from 5% to 60%. Our study offers a quantitative framework for stratifying children with MPP by their risk of refractory disease and treatment intensification.

Introduction:
Mycoplasma pneumoniae carries a clinically important risk of a refractory course or the need for intensified corticosteroid therapy. No admission-day prediction tool has been validated to identify children at risk for either outcome.

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