Abstract
BACKGROUND: This study aimed to investigate the clinical features and risk factors of Mycoplasma pneumoniae necrotizing pneumonia (MPNP) in children, providing a scientific basis for early diagnosis, effective treatment, and preventive strategies. METHODS: A retrospective analysis of 138 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) admitted to the Children’s Hospital Affiliated to Zhengzhou University from August 2023 to December of the same year was performed. The patient population was divided into the MPNP group (41 cases) and the N-NP (N-Necrotizing pneumonia) group (97 cases) based on the presence or absence of comorbid MPNP. Baseline data, laboratory results, and imaging characteristics were compared. Logistic regression was used to identify risk factors for MPNP, and receiver operating characteristic (ROC) curve analysis was applied to evaluate diagnostic efficacy. RESULTS: Compared with the N-NP group, children in the MPNP group showed older age, longer hospitalization days, higher fever peak and fever days, and higher rates of chest pain, dyspnea, shortness of breath and combined extrapulmonary complications (all P < 0.05). Laboratory findings showed elevated white blood cells (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin−6 (IL−6), serum amyloid A (SAA), serum ferritin (SF), D-dimer (D-D), alanine aminotransferase (ALT), aspartate aminotransferase (AST), immunoglobulin A (IgA), immunoglobulin M (IgM), and lactate dehydrogenase (LDH). While total protein (TP), Albumin (ALB), complement component 4 (C4) levels were significantly lower (P < 0.05). The proportion of children with combined pleural effusion and the percentage of those who underwent fiberoptic bron-choscopic alveolar lavage (FBAL) with alveolar lavage were higher in the MPNP group than in the N-NP group (P < 0.05). Multivariate logistic regression identified age, fever days, D-D, LDH and pleural effusion as independent risk factors for MPNP. ROC curve analysis indicated that children with MPP who were aged > 5.45 years, fever days > 7.5 days, D-D > 0.73 mg/L, LDH > 399 U/L and concurrent pleural effusion predicted MPNP with a sensitivity of 0.878, specificity of 0.876, and area under the curve (AUC) of 0.940 (95%CI: 0.900−0.979). CONCLUSION: Age, fever days, D-D, LDH, and pleural effusion are independent risk factors for MPNP in children. These factors should be closely examined in clinical practice in children with MPP to alert them to the potential risk of NP. Early identification of changes in these risk factors and implementation of timely and effective interventions hold significant clinical value for preventing and controlling the risk of MPP children developing MPNP.