Analysis Of Clinical Characteristics And Related Risk Factors Of Severe Mycoplasma Pneumoniae Pneumonia In Children

Objective:To explore the clinical characteristics and related risk factors of severe mycoplasma pneumoniae pneumonia（SMPP）in children,so as to provide guidance for early identification of SMPP.Methods:A total of 263 children with acute mycoplasma pneumoniae pneumonia（MPP）hospitalized in the Department of Respiratory Medicine of Anhui Children’s Hospital from January 2019 to December 2021 were analyzed retrospectively.According to the condition,the children were divided into two groups: severe group（n = 88）and mild group（n = 175）.The general data,clinical features,laboratory indexes,imaging manifestations,bronchoscopic manifestations and treatment plans of the two groups were collected.Univariate analysis was made on the clinical data of the two groups.Then,the indexes with statistically significant differences between the two groups were taken as independent variables,and the severity of the disease was grouped as dependent variables,which was included in the binary Logistic regression equation.The independent risk factors of SMPP were analyzed and the prediction probability was calculated.The ROC curve was drawn,the area under the ROC curve,the optimal critical value,specificity and sensitivity were calculated,and the screening value of independent risk factors in SMPP was evaluated.Results:1.General data: The average age of children with MPP in severe group was higher than that in mild group,and the difference was statistically significant.When the age was further segmented,the incidence of SMPP in preschool children was the highest,followed by school age children.,the incidence of SMPP in infants was significantly lower than that in other age groups.（P < 0.05）.2.Clinical features: The duration of fever,length of stay were significantly longer than those in the mild group,and the difference was statistically significant（P < 0.05）.The incidence of fever degree and extrapulmonary complications in the severe group was higher than that in the mild group,and there was significant difference between the two groups（P < 0.05）.3.Laboratory indexes: C-reactive protein（CRP）,white blood cell count / lymphocyte count（WBC/LYM）,glutamic pyruvic transaminase（ALT）,lactate dehydrogenase（LDH）,immunoglobulin G（Ig G）,immunoglobulin A（Ig A）,erythrocyte sedimentation rate（ESR）,D-dimer（Di）and procalcitonin（PCT）in severe group were significantly higher than those in mild group.Prealbumin（PA）in severe group was lower than that in mild group,and the difference was statistically significant（P < 0.05）.The replication ratio of high mycoplasma pneumoniae DNA（MP-DNA）in severe group was mainly high,while that in mild group was low MP-DNA replication multiple.There was significant difference between the two groups（P < 0.05）.4.Imaging findings: The proportion of pleural effusion,atelectasis and lung consolidation in the severe group was significantly higher than that in the mild group,and the difference was statistically significant（P < 0.05）.The pathological changes were mainly patchy shadow in the severe group and patchy or cloudy shadow in the mild group,and there was significant difference between the two groups（P < 0.05）.5.Bronchoscopic manifestations: Congestion and swelling of airway mucosa and adhesion of viscous secretions were seen in all children under bronchoscope.The probability of mucus thrombus blockage in severe group was significantly higher than that in mild group（P < 0.05）.6.Treatment: The use time of macrolides,the proportion of gamma globulin and hormone therapy and the frequency of bronchoalveolar lavage（BAL）in the severe group were significantly higher than those in the mild group,and the difference was statistically significant.（P < 0.05）.The indexes with statistical differences in univariate analysis were taken as independent variables,and the severity of the disease was grouped as dependent variables,which were included in the binary Logistic regression equation.The results showed that heat course[OR=1.294（95% CI:1.127,1.485）],CRP[OR=1.027（95% CI:1.003,1.052）],LDH[OR=1.006（95% CI:1.002,1.011）],Di[OR=1.406（95% CI:1.065,1.875）],ESR[OR=1.042（95% CI:1.008,1.077）],pleural effusion[OR=5.495（95% CI:1.604,18.826）] and large patchy shadow [OR=21.811（95% CI:6.205,76.664）] were independent risk factors for SMPP（P <0.05）.The area under the curve（AUC）of heat course,CRP,LDH,Di and ESR were calculated,and the order was Di > heat course > ESR > CRP > LDH.The optimal critical values were 0.98mg/L,8.50 days,36.5mm/h,25.625mg/L and 412.50IU/L,respectively.Conclusion:1.The age of children in the severe group was significantly older than that in the mild group,in which the incidence of SMPP in preschool children was the highest,followed by school-age children,and the incidence of SMPP in infants was significantly lower than that in other age groups.There was no significant correlation between the severity of MPP and the seasons.2.Most of the children in the severe group had high fever,and the duration of fever,length of stay and use of macrolides in the severe group were significantly longer than those in the mild group,and most of the inflammatory indexes were significantly higher than those in the mild group.the incidence of massive shadow of lung,airway mucus thrombus,the use of gamma globulin,hormone therapy and the frequency of bronchoalveolar lavage in the severe group were significantly higher than those in the mild group.3.Heat course,CRP,LDH,Di,ESR,pleural effusion and large sheet lesions were independent risk factors for SMPP（P<0.05）,which were of great significance for early identification of SMPP.