Abstract
BACKGROUND: Radiologic complications of pediatric Mycoplasma pneumoniae pneumonia (MPP), consolidation, and necrotizing pneumonia (NP) are difficult to anticipate early. We tested whether admission cytokines and short-term changes predict imaging outcomes. METHODS: A retrospective cohort (Oct 2022-Sep 2024) of hospitalized children with PCR-confirmed MPP. Multiplex cytokines (including IL-6, IL-10, CXCL10/IP-10) were assayed from residual samples at admission (T0) and days 3-5 (T1). NP analyses were conditional on undergoing computed tomography (CT). Primary outcomes were WHO end-point CXR consolidation ≤14 days and CT-defined NP ≤28 days. Full-cohort 14-day CXR-consolidation risk (admission), post-T1 consolidation risk among event-free children (day 3-5 landmark), and 28-day NP risk conditional on being scanned. Penalized logistic models evaluated T0 and Δ(T0-T1) predictors among children event-free at T1, with AUC (bootstrap-corrected) and BH-FDR control. RESULTS: Of 286 enrollments, 268 were analyzed; consolidation occurred in 96/268 (35.8%), CT was performed in 124/268 (46.3%), and identified NP in 28/124 (22.6%; 10.4% overall). In the Admission model, IL-6 (adjusted OR [aOR] 1.45, 95% CI 1.16-1.83; q=0.01), IP-10 (1.52, 1.21-1.93; q<0.01), and IL-10 (1.28, 1.03-1.60; q=0.04) predicted consolidation (AUC 0.78, 95% CI 0.73-0.83). In event-free children at T1 (n=180), ΔIL 6 (1.40, 1.12-1.76) and ΔIP 10 (1.48, 1.18-1.88) improved discrimination (AUC 0.84, 0.79-0.88). In CT-subset models, T0 IL-6 (1.67, 1.09-2.58) and ΔIL-6 (1.89, 1.22-3.00) were associated with NP (AUC 0.79). Findings were robust in prespecified sensitivity analyses. CONCLUSIONS: Admission cytokines and early rises, especially IL-6 and IP-10, enable pragmatic early risk stratification for consolidation, with ΔIL-6 also signaling NP risk in the CT-scanned subset. These results support external validation of a cytokine-based tool to inform imaging and triage.