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Ma K, Liu X, Wu XT, Wang TJ, Li KL, Wang DB, Li SJ. The correlation between the level of cellular classification in bronchoalveolar lavage fluid of children with severe Mycoplasma pneumoniae and clinical characteristics. Eur J Pediatr 2024; 183:4351-4362. [PMID: 39093423 DOI: 10.1007/s00431-024-05700-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
Mycoplasma pneumoniae pneumonia (MPP) is a common respiratory tract infection disease in children. To date, there have been few studies on the relationship between cytological changes in bronchoalveolar lavage fluid (BALF) and clinical features. The objective of this study is to investigate the correlation between changes in the proportion of cell classifications in BALF and the clinical features in children with severe MPP (SMPP). In total, the study included 64 children with SMPP requiring bronchoalveolar lavage who were admitted to our hospital between March and September 2022 (study group) and 11 children with bronchial foreign bodies without co-infection (control group), who were admitted during the same period. The proportion of cell classifications in BALF was determined by microscopic examination after performing Wright-Giemsa staining. Patients were grouped according to different clinical characteristics, and between-group comparisons were made regarding the variations in the proportion of cell classifications in BALF. The levels of blood routine neutrophil percentage (GRA%), C-reactive protein, D-dimer and lactate dehydrogenase in the study group were higher than those in the control group (P < 0.05). There were differences in the GRA% and macrophage percentage in the BALF between the two groups (P < 0.05). The GRA% and blood lymphocyte percentage were associated with pleural effusion. Multiple indicators correlated with extrapulmonary manifestations (P < 0.05). Moreover, the percentage of lymphocytes in the BALF correlated with pleural effusion, extrapulmonary manifestations and refractory MPP (RMPP) (P < 0.05). Logistic regression showed that BALF lymphocytes were protective factors for RMPP, while serum amyloid A and extrapulmonary manifestations were risk factors (P < 0.05). CONCLUSION The BALF of children with SMPP is predominantly neutrophilic. A lower percentage of lymphocytes is related to a higher incidence of pleural effusion, extrapulmonary manifestations and progression to RMPP, as well as a longer length of hospitalisation. WHAT IS KNOWN • Mycoplasma pneumonia in children is relatively common in clinical practice. Bronchoalveolar lavage (BAL) is a routine clinical procedure. WHAT IS NEW However, there are relatively few studies focusing on the cytomorphological analysis of cells in BAL fluid.
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Affiliation(s)
- Kun Ma
- Department of Pediatrics, People's Hospital of Zhecheng County, Shangqiu, 476200, China
| | - Xue Liu
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan Province, China
| | - Xiang-Tao Wu
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan Province, China
| | - Tuan-Jie Wang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan Province, China
| | - Kai-Li Li
- Department of Pediatrics, People's Hospital of Zhecheng County, Shangqiu, 476200, China
| | - Dao-Bin Wang
- Department of Pediatrics, People's Hospital of Zhecheng County, Shangqiu, 476200, China
| | - Shu-Jun Li
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan Province, China.
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Zeng Q, Li Y, Yue Y, Wang M, Yang C, Lv X. Epidemiological characteristics and early predict model of children Mycoplasma Pneumoniae Pneumonia outbreaks after the COVID-19 in Shandong. Sci Rep 2024; 14:19892. [PMID: 39192024 DOI: 10.1038/s41598-024-71010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/23/2024] [Indexed: 08/29/2024] Open
Abstract
Since October 2023, a significant outbreak of Mycoplasma Pneumoniae Pneumonia (MPP) has been observed in children in northern China. Chinese health authorities have attributed this epidemiological to immune debt resulting from the relaxation of coronavirus disease 2019 (COVID-19) control measures. This study described the epidemiological features of Mycoplasma pneumoniae (MP) prevalence in children and developed a straightforward prediction model to differentiate between MPP and viral pneumonia in children. The infection rate of MP in children notably increased from 8.12 in 2022 to 14.94% in 2023, peaking between October and November, especially among school-age children. Logistic regression screening identified four key indicators: Age, D-Dimer levels, erythrocyte sedimentation rate, and gender. The developed nomogram exhibited a receiver operator characteristic curve-area under the curve (ROC-AUC) of 0.858, with external validation confirming an ROC-AUC of 0.794. This study examined the epidemiological characteristics of MPP prevalence in children in Shandong Province during and after the COVID-19 pandemic. An early predict model was developed and validated to differentiate between Mycoplasma Pneumoniae and viral infections.
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Affiliation(s)
- Qian Zeng
- Clinical Laboratory, Children's Hospital Affiliated to Shandong University, 23976 Jing-Shi Road, Jinan, 250022, Shandong Province, People's Republic of China
- Clinical Laboratory, Jinan Children's Hospital, Jinan, People's Republic of China
| | - Yurong Li
- Clinical Laboratory, Children's Hospital Affiliated to Shandong University, 23976 Jing-Shi Road, Jinan, 250022, Shandong Province, People's Republic of China
- Clinical Laboratory, Jinan Children's Hospital, Jinan, People's Republic of China
| | - Yuanyuan Yue
- Clinical Laboratory, Children's Hospital Affiliated to Shandong University, 23976 Jing-Shi Road, Jinan, 250022, Shandong Province, People's Republic of China
- Clinical Laboratory, Jinan Children's Hospital, Jinan, People's Republic of China
| | - Min Wang
- Clinical Laboratory, Children's Hospital Affiliated to Shandong University, 23976 Jing-Shi Road, Jinan, 250022, Shandong Province, People's Republic of China
- Clinical Laboratory, Jinan Children's Hospital, Jinan, People's Republic of China
| | - Chun Yang
- Clinical Laboratory, Children's Hospital Affiliated to Shandong University, 23976 Jing-Shi Road, Jinan, 250022, Shandong Province, People's Republic of China.
- Clinical Laboratory, Jinan Children's Hospital, Jinan, People's Republic of China.
| | - Xin Lv
- Clinical Laboratory, Children's Hospital Affiliated to Shandong University, 23976 Jing-Shi Road, Jinan, 250022, Shandong Province, People's Republic of China.
- Clinical Laboratory, Jinan Children's Hospital, Jinan, People's Republic of China.
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Pei H, Luo H. Predictive clinical indicators of refractory Mycoplasma pneumoniae pneumonia in children: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e39375. [PMID: 39183437 PMCID: PMC11346851 DOI: 10.1097/md.0000000000039375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/30/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024] Open
Abstract
To determine the clinical indicators predictive of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and develop a robust predictive model to aid in early identification and management. A retrospective cohort study was conducted on 338 children diagnosed with RMPP out of a total of 1500 cases of Mycoplasma pneumoniae at a single tertiary hospital from May 2021 to November 2023. Clinical and demographic data analyzed included age, gender, parents' educational level, household income, body mass index, allergic constitution, and laboratory findings such as white blood cell count, neutrophil and lymphocyte counts, platelet count, and levels of C-reactive protein (CRP), D-dimer, and procalcitonin. Univariate and multivariate logistic regression analyses were performed to identify significant predictors of RMPP, and a predictive model was developed. Among the RMPP cohort, 52.4% were female, with a mean age of 6.07 ± 2.78 years. Multivariate analysis identified several significant predictors of poor prognosis, including higher body mass index, longer duration of fever, elevated white blood cell count, neutrophil count, C-reactive protein levels, and increased neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. The model demonstrated outstanding diagnostic performance, with an area under the receiver operating characteristic curve of 0.963 (95% confidence interval: 0.946-0.981). Our study identifies key clinical indicators with significant diagnostic accuracy for predicting RMPP in children. The predictive model established offers a valuable tool for clinicians, potentially improving RMPP outcomes through timely intervention.
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Affiliation(s)
- Hong Pei
- Department of Pharmacy, Hejiang People’s Hospital, Luzhou City, Sichuan Province, China
| | - Hongli Luo
- Department of Clinical Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou City, Sichuan Province, China
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Wei D, Zhao Y, Zhang T, Xu Y, Guo W. The role of LDH and ferritin levels as biomarkers for corticosteroid dosage in children with refractory Mycoplasma pneumoniae pneumonia. Respir Res 2024; 25:266. [PMID: 38965565 PMCID: PMC11225272 DOI: 10.1186/s12931-024-02892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 06/25/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND This study explored the relationship between inflammatory markers and glucocorticoid dosage upon admission. METHODS We conducted a retrospective analysis of 206 patients with refractory Mycoplasma pneumoniae pneumonia (RMPP) admitted to a Children's Hospital from November 2017 to January 2022. Patients were categorized into three groups based on their methylprednisolone dosage: low-dose (≤ 2 mg/kg/d), medium-dose (2-10 mg/kg/d), and high-dose (≥ 10 mg/kg/d). We compared demographic data, clinical manifestations, laboratory findings, and radiological outcomes. Spearman's rank correlation coefficient was used to assess relationships between variables. RESULTS The median age was highest in the low-dose group at 7 years, compared to 5.5 years in the medium-dose group and 6 years in the high-dose group (P < 0.001). The body mass index (BMI) was also highest in the low-dose group at 16.12, followed by 14.86 in the medium-dose group and 14.58 in the high-dose group (P < 0.001). More severe radiographic findings, longer hospital stays, and greater incidence of hypoxia were noted in the high-dose group (P < 0.05). Additionally, significant increases in white blood cells, C-reactive protein, procalcitonin, lactate dehydrogenase (LDH), alanine transaminase, aspartate transaminase, ferritin, erythrocyte sedimentation rate, and D-dimer levels were observed in the high-dose group (P < 0.05). Specifically, LDH and ferritin were markedly higher in the high-dose group, with levels at 660.5 U/L and 475.05 ng/mL, respectively, compared to 450 U/L and 151.4 ng/mL in the medium-dose group, and 316.5 U/L and 120.5 ng/mL in the low-dose group. Correlation analysis indicated that LDH and ferritin levels were significantly and positively correlated with glucocorticoid dose (Spearman ρ = 0.672 and ρ = 0.654, respectively; P < 0.001). CONCLUSIONS Serum LDH and ferritin levels may be useful biomarkers for determining the appropriate corticosteroid dosage in treating children with RMPP.
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Affiliation(s)
- DiWei Wei
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
- Children's Clinical College of Tianjin Medical University, Tianjin, China
| | - YiDi Zhao
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
- Children's Clinical College of Tianjin Medical University, Tianjin, China
| | - TongQiang Zhang
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
| | - YongSheng Xu
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
| | - Wei Guo
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China.
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Lu W, Wu X, Xu Y, Wang T, Xiao A, Guo X, Xu Y, Li D, Li S. Predictive value of bronchoscopy combined with CT score for refractory mycoplasma pneumoniae pneumonia in children. BMC Pulm Med 2024; 24:251. [PMID: 38778338 PMCID: PMC11110382 DOI: 10.1186/s12890-024-02996-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Mycoplasma pneumoniae pneumonia (MPP) is prevalent in paediatric patients and can progress to refractory mycoplasma pneumoniae pneumonia (RMPP). OBJECTIVE To assess the predictive value of bronchoscopy combined with computed tomography (CT) score in identifying RMPP in children. METHODS A retrospective analysis was conducted on 244 paediatric patients with MP, categorising them into RMPP and general mycoplasma pneumoniae pneumonia (GMPP) groups. A paired t-test compared the bronchitis score (BS) and CT score before and after treatment, supplemented by receiver operating characteristic (ROC) analysis. RESULTS The RMPP group showed higher incidences of extrapulmonary complications and pleural effusion (58.10% and 40%, respectively) compared with the GMPP group (44.60%, p = 0.037 and 18.71%, p < 0.001, respectively). The CT scores for each lung lobe were statistically significant between the groups, except for the right upper lobe (p < 0.05). Correlation analysis between the total CT score and total BS yielded r = 0.346 and p < 0.001. The ROC for BS combined with CT score, including area under the curve, sensitivity, specificity, and cut-off values, were 0.82, 0.89, 0.64, and 0.53, respectively. CONCLUSION The combined BS and CT score method is highly valuable in identifying RMPP in children.
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Affiliation(s)
- Weihong Lu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China.
| | - Xiangtao Wu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Yali Xu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Tuanjie Wang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Aiju Xiao
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Xixia Guo
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Yuping Xu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Duoduo Li
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China.
| | - Shujun Li
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China.
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Liu C, Wang R, Ge S, Wang B, Li S, Yan B. Research status and challenges of Mycoplasma pneumoniae pneumonia in children: A bibliometric and visualization analysis from 2011 to 2023. Medicine (Baltimore) 2024; 103:e37521. [PMID: 38489686 PMCID: PMC10939570 DOI: 10.1097/md.0000000000037521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae (MP) infections occur in regional outbreaks every 3 to 7 years, lasting up to 2 years. Since this fall, there has been a significant rise in MP infections among children in China, indicating a regional epidemiological trend that imposes an increased national public health burden. To date, bibliometric methods have not been applied to studies on MP infection in children. METHODS We searched for all relevant English publications on MP pneumonia in children published from 2011 to 2023 using Web of Science. Analytical software tools such as Citespace and VOSviewer were employed to analyze the collected literature. RESULTS 993 articles on MP pneumonia in children were published in 338 academic journals by 5062 authors affiliated with 1381 institutions across 75 countries/regions. China led in global productivity with 56.19%. Among the top 10 prolific organizations, 8 were Chinese institutions, with Soochow University being the most active, followed by Capital Medical University and Zhejiang University. Zhimin Chen from Zhejiang University School of Medicine exhibited the highest H-index of 32. Keyword co-occurrence network analysis revealed 7 highly relevant clusters. CONCLUSION The current research hotspots and frontiers in this field are primarily MP pneumonia, refractory MP pneumonia, lactate dehydrogenase, asthma, and biomarker. We anticipate that this work will provide novel insights for advancing scientific exploration and the clinical application of MP pneumonia in children.
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Affiliation(s)
- Congcong Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuyi Ge
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Binding Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siman Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bohua Yan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Li M, Wei X, Zhang SS, Li S, Chen SH, Shi SJ, Zhou SH, Sun DQ, Zhao QY, Xu Y. Recognition of refractory Mycoplasma pneumoniae pneumonia among Myocoplasma pneumoniae pneumonia in hospitalized children: development and validation of a predictive nomogram model. BMC Pulm Med 2023; 23:383. [PMID: 37817172 PMCID: PMC10566172 DOI: 10.1186/s12890-023-02684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUD The current diagnostic criteria for refractory Mycoplasma pneumoniae pneumonia (RMPP) among Mycoplasma pneumoniae Pneumonia (MPP) are insufficient for early identification, and potentially delayed appropriate treatment. This study aimed to develop an effective individualized diagnostic prediction nomogram for pediatric RMPP. METHODS A total of 517 hospitalized children with MPP, including 131 with RMPP and 386 without RMPP (non-RMPP), treated at Lianyungang Maternal and Child Health Care Hospital from January 2018 to December 2021 were retrospectively enrolled as a development (modeling) cohort to construct an RMPP prediction nomogram. Additionally, 322 pediatric patients with MPP (64 with RMPP and 258 with non-RMPP, who were treated at the Affiliated Hospital of Xuzhou Medical University from June 2020 to May 2022 were retrospectively enrolled as a validation cohort to assess the prediction accuracy of model. Univariable and multivariable logistic regression analyses were used to identify RMPP risk factors among patients with MPP. Nomogram were generated based on these risk factors using the rms package of R, and the predictive performance was evaluated based on receiver operating characteristic (ROC) curves and using decision curve analysis (DCA). RESULTS Multivariate analysis revealed five significant independent predictors of RMPP among patients with MPP: age (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.08-1.33, P = 0.038), fever duration (HR 1.34, 95%CI 1.20-1.50, P < 0.001), lymphocyte count (HR 0.45, 95%CI 0.23-0.89, P = 0.021), serum D-dimer (D-d) level (HR 1.70, 95%CI 1.16-2.49, P = 0.006), and pulmonary imaging score (HR 5.16, 95%CI 2.38-11.21, P < 0.001). The area under the ROC curve was 90.7% for the development cohort and 96.36% for the validation cohort. The internal and external verification calibration curves were almost linear with slopes of 1, and the DCA curve revealed a net benefit with the final predictive nomogram. CONCLUSION This study proposes a predictive nomogram only based on five variables. The nomogram can be used for early identification of RMPP among pediatric patients with MPP, thereby facilitating more timely and effective intervention.
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Affiliation(s)
- Meng Li
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiang Wei
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Shan-Shan Zhang
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Shan Li
- Department of Pediatric Endocrinology, Lianyungang Maternal and Child Health Care Hospital, Lianyungang, Jiangsu, China
| | - Su-Hong Chen
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Su-Jie Shi
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Shao-Hong Zhou
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Da-Quan Sun
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Qian-Ye Zhao
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China.
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
| | - Yan Xu
- Neonatology Department, The Affiliated Hospital of Xuzhou Medical University, No. 99, Huaihai West Road, Quanshan District, Xuzhou, 221000, Jiangsu, China.
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Wu X, Lu W, Sang X, Xu Y, Wang T, Zhan X, Hao J, Ren R, Zeng H, Li S. Timing of bronchoscopy and application of scoring tools in children with severe pneumonia. Ital J Pediatr 2023; 49:44. [PMID: 37024936 PMCID: PMC10079491 DOI: 10.1186/s13052-023-01446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND There is still a lack of effective scoring criteria for assessing the severity of pulmonary infection associated with changes in the endobronchial lining of the bronchus in children. This study aimed to ascertain the timing and value of endoscopic scoring of fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in children with severe pneumonia. METHOD The clinical data of 229 children with severe pneumonia treated with BAL in the Pediatric Intensive Care Unit of the First Affiliated Hospital of Xinxiang Medical University between November 2018 and December 2021 were collected. According to the severity of the disease, patients were divided into an invasive ventilation group and a non-invasive ventilation group, as well as an early BAL group (receiving BAL within 1 day of admission) and a late BAL group (receiving BAL 2 days after admission). A Student's t-test, Chi-square test, receiver operating characteristic (ROC) curve and survival curve were used to analyse the bronchitis score, aetiology of BAL fluid and survival data. RESULTS The scores of endoscopic mucosal oedema, erythema and pallor and the total score in the invasive ventilation group were higher than those in the non-invasive ventilation group (P < 0.05), and they were consistent with the Sequential Organ Failure Assessment (SOFA) scores. The secretion colour score was lower in the early BAL group than in the late BAL group (P < 0.05). On the bronchitis scores, which were evaluated using a ROC curve, the difference in the mucosal erythema, pallor, oedema and total score of the invasive and non-invasive groups was statistically significant (P < 0.05), which was consistent with the area under the ROC of the SOFA scores. Acute Physiology and Chronic Health Assessment II and SOFA scores after FOB were lower than those before treatment (P < 0.05). In terms of ICU hospitalisation days and total hospitalisation days, the time of the early FOB patients was shorter than that of the late FOB patients (P < 0.05). A total of 22 patients (9.61%) died. The Kaplan-Meier analysis and log-rank test showed that the survival rate of the non-invasive ventilation group was higher than that of the invasive ventilation group (P < 0.05). CONCLUSION This study found that FOB combined with BAL is an important method for the diagnosis and treatment of severe pneumonia. Early BAL can reduce hospitalisation and ICU time; however, it cannot improve the survival rate. The endoscopic score has a certain role to play in assessing the severity of pulmonary inflammation, but studies with a large sample are still needed to confirm this.
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Affiliation(s)
- Xiangtao Wu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Weihong Lu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Xinquan Sang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Yali Xu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Tuanjie Wang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Xiaowen Zhan
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Jie Hao
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Ruijuan Ren
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Hanshi Zeng
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China
| | - Shujun Li
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China.
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Development and validation of a nomogram for predicting Mycoplasma pneumoniae pneumonia in adults. Sci Rep 2022; 12:21859. [PMID: 36528731 PMCID: PMC9759542 DOI: 10.1038/s41598-022-26565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The study aimed to explore predictors of Mycoplasma pneumoniae pneumonia (MPP) in adults and develop a nomogram predictive model in order to identify high-risk patients early. We retrospectively analysed the clinical data of a total of 337 adult patients with community-acquired pneumonia (CAP) and divided them into MPP and non-MPP groups according to whether they were infected with MP. Univariate and multivariate logistic regression analyses were used to screen independent predictors of MPP in adults and to developed a nomogram model. Receiver operating characteristic (ROC) curve, calibration curve, concordance index (C-index), and decision curve analysis (DCA) were used for the validation of the evaluation model. Finally, the nomogram was further evaluated by internal verification. Age, body temperature, dry cough, dizziness, CRP and tree-in-bud sign were independent predictors of MPP in adults (P < 0.05). The nomogram showed high accuracy with C-index of 0.836 and well-fitted calibration curves in both the training and validation sets. The area under the receiver operating curve (AUROC) was 0.829 (95% CI 0.774-0.883) for the training set and 0.847 (95% CI 0.768-0.925) for the validation set. This nomogram prediction model can accurately predict the risk of MPP occurrence in adults, which helps clinicians identify high-risk patients at an early stage and make drug selection and clinical decisions.
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Xie Q, Zhang X, Cui W, Pang Y. Construction of a Nomogram for Identifying Refractory Mycoplasma pneumoniae Pneumonia Among Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children. J Inflamm Res 2022; 15:6495-6504. [PMID: 36474517 PMCID: PMC9719700 DOI: 10.2147/jir.s387809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/15/2022] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE The individualized prediction of treatment regimens of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) is scarce. The aim of this study was, therefore, to evaluate the relevant data of patients and construct a nomogram for identifying refractory Mycoplasma pneumoniae pneumonia (RMPP) among children continued to be treated with macrolide after the confirmation of MUMPP, providing a reference for the choice of treatment regimen. METHODS We performed a retrospective study involving 162 children who continued to be treated with macrolide (azithromycin) after the confirmation of MUMPP without antibiotic changes between January 2020 and January 2022. We collected data on clinical feature, hospitalization period, treatments, laboratory data, extrapulmonary symptoms, parapneumonic effusion, and connections with other respiratory pathogens. In addition, the independent risk factors for RMPP were determined through univariate and multivariate analyses, and then a nomogram was constructed and validated. RESULTS In this study, the multivariate logistic regression analysis showed that age, leukocyte count, neutrophil proportion, serum procalcitonin, and lactate dehydrogenase were independent risk factors for RMPP. Using the five independent associated factors, the nomogram for identification of RMPP was constructed. Moreover, the area under the ROC curve (AUC) was 0.925 (95% CI: 0.882-0.968) for the nomogram showing excellent discrimination. The calibration curve, close to the 45-degree line, exhibited good calibration of nomogram. CONCLUSION We constructed and validated a visual and user-friendly nomogram for individualized prediction of RMPP risk in children who continued to be treated with macrolide after the confirmation of MUMPP based on five variables. According to the nomogram model, continuation of macrolide should be considered rather than second-line antibiotics including tetracyclines (doxycycline or minocycline) and fluoroquinolones for MUMPP children with low predictive values.
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Affiliation(s)
- Qiaoyi Xie
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xiaote Zhang
- Department of Otolaryngology Head and Neck Surgery, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
| | - Wei Cui
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yajiao Pang
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
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Liu G, Wang G, Yang Z, Liu G, Ma H, Lv Y, Ma F, Zhu W. A Lung Ultrasound-Based Nomogram for the Prediction of Refractory Mycoplasma pneumoniae Pneumonia in Hospitalized Children. Infect Drug Resist 2022; 15:6343-6355. [PMCID: PMC9635389 DOI: 10.2147/idr.s387890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gangtie Liu
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, People’s Republic of China
- Department of Pediatrics, Taian Maternity and Child Health Care Hospital, Taian, People’s Republic of China
| | - Guanglei Wang
- Department of Pediatrics, Taian Maternity and Child Health Care Hospital, Taian, People’s Republic of China
| | - Zhan Yang
- Department of Pediatrics, Taian Maternity and Child Health Care Hospital, Taian, People’s Republic of China
| | - Guangfu Liu
- Department of Radiology, Taian Maternity and Child Health Care Hospital, Taian, People’s Republic of China
| | - Haijun Ma
- Department of Radiology, Taian Maternity and Child Health Care Hospital, Taian, People’s Republic of China
| | - Yong Lv
- Department of Pediatrics, Taian Maternity and Child Health Care Hospital, Taian, People’s Republic of China
| | - Feiyan Ma
- Department of Pediatrics, Taian Maternity and Child Health Care Hospital, Taian, People’s Republic of China
| | - Weiwei Zhu
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, People’s Republic of China
- Correspondence: Weiwei Zhu, Department of Pediatrics, Jinan Central Hospital, Shandong University, No. 105 Jiefang Road, Jinan, 250013, People’s Republic of China, Tel +86-538-6620622, Email
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Lee E, Choi I. Clinical Usefulness of Serum Lactate Dehydrogenase Levels in Mycoplasma pneumoniae Pneumonia in Children. Indian J Pediatr 2022; 89:1003-1009. [PMID: 35665905 DOI: 10.1007/s12098-022-04205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/16/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To elucidate the clinical usefulness of lactate dehydrogenase (LDH) levels in children with Mycoplasma pneumoniae (MP) pneumonia and identify cut-off levels in various clinical conditions. METHODS The study was retrospectively performed in 145 children who were hospitalized with MP pneumonia. Laboratory findings, including LDH levels at admission and clinical features were retrospectively reviewed from patients' electronic medical records. RESULTS The mean age of the study population was 5.9 y, and the mean value of LDH was 809.7 U/L. Poor response to treatment for MP pneumonia, respiratory virus coinfection, severe MP pneumonia, development of postinfectious bronchiolitis obliterans (PIBO) after MP pneumonia, pleural effusion, and oxygen need during illness were significantly associated with serum LDH levels. The cutoff levels of LDH for predicting poor response to treatment for MP pneumonia and respiratory virus coinfection were 1058 U/L [area under the curve (AUC), 0.729] and 803 U/L (AUC, 0.682), respectively. Those for pneumonic lesions involving at least one-third of the total lung volume, prediction of PIBO development, and extrapulmonary manifestations were 1098 U/L (AUC, 0.715), 676 U/L (AUC, 0.714), and 859 U/L (AUC, 0.710), respectively. The cutoff levels for pleural effusion during illness and for the prediction of oxygen need were 894 U/L (AUC, 0.699) and 1114 U/L (AUC, 0.771), respectively. CONCLUSION LDH levels are elevated in diverse clinical conditions in children with MP pneumonia and may be useful in the identification of severe clinical courses of MP pneumonia in children.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea.
| | - Insu Choi
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea
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Zhao L, Zhang T, Cui X, Zhao L, Zheng J, Ning J, Xu Y, Cai C. Development and validation of a nomogram to predict plastic bronchitis in children with refractory Mycoplasma pneumoniae pneumonia. BMC Pulm Med 2022; 22:253. [PMID: 35761218 PMCID: PMC9235233 DOI: 10.1186/s12890-022-02047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background Early identification of plastic bronchitis (PB) is of great importance and may aid in delivering appropriate treatment. This study aimed to develop and validate a nomogram for predicting PB in patients with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods A total of 547 consecutive children with RMPP who underwent fiberoptic bronchoscopy (FOB) intervention from January 2016 to June 2021 were enrolled in this study. Subsequently, 374 RMPP children (PB: 137, without PB: 237) from January 2016 to December 2019 were assigned to the development dataset to construct the nomogram to predict PB and 173 RMPP children from January 2020 to June 2021 were assigned to the validation dataset. The clinical, laboratory and radiological findings were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression was applied to construct a nomogram. The performance of the nomogram was evaluated by discrimination, calibration and clinical utility. Comparsion of ROC analysis and decision curve analysis (DCA) between nomogram and other models was performed to evaluate the discrimination ability and clinical utility. Results The development dataset included 374 patients with a mean age of 6.6 years and 185(49.5%) were men. The validation dataset included 173 patients and the mean age of the dataset was 6.7 years and 86 (49.7%) were men. From 26 potential predictors, LASSO regression identified 6 variables as significant predictive factors to construct the nomogram for predicting PB, including peak body temperature, neutrophil ratio (N%), platelet counts (PLT), interleukin-6 (IL-6), actic dehydrogenase (LDH) and pulmonary atelectasis. The nomogram showed good discrimination, calibration and clinical value. The mean AUC of the nomogram was 0.813 (95% CI 0.769–0.856) in the development dataset and 0.895 (95% CI 0.847–0.943) in the validation dataset. Through calibration plot and Hosmer–Lemeshow test, the predicted probability had a good consistency with actual probability both in the development dataset (P = 0.217) and validation dataset (P = 0.183), and DCA showed good clinical utility. ROC analysis indicated that the nomogram showed better discrimination ability compared with model of peak body temperature + pulmonary atelactsis and another model of N% + PLT + IL-6 + LDH, both in development dataset (AUC 0.813 vs 0.757 vs 0.754) and validation dataset (AUC 0.895 vs 0.789 vs 0.842). Conclusions In this study, a nomogram for predicting PB among RMPP patients was developed and validated. It performs well on discrimination ability, calibration ability and clinical value and may have the potential for the early identification of PB that will help physicians take timely intervention and appropriate management. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02047-2.
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Choo S, Lee YY, Lee E. Clinical significance of respiratory virus coinfection in children with Mycoplasma pneumoniae pneumonia. BMC Pulm Med 2022; 22:212. [PMID: 35637540 PMCID: PMC9150047 DOI: 10.1186/s12890-022-02005-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia has been increasing. However, few studies have investigated the impact of respiratory virus coinfection in patients with MP pneumonia, and their results have been inconclusive. This study aimed to investigate the impact of respiratory virus coinfection in children hospitalized with MP pneumonia. METHODS This study enrolled 145 children hospitalized with MP pneumonia between May 2019 and March 2020. The patients were divided into two groups: the respiratory virus coinfection and non-coinfection groups. All the children underwent polymerase chain reaction testing for respiratory virus infection. Information on clinical, laboratory, and radiologic findings were obtained retrospectively via medical chart reviews. RESULTS Children in the respiratory virus coinfection group were younger than those in the non-coinfection group. Respiratory virus coinfection in children hospitalized with MP pneumonia was significantly associated with persistence of fever more than 6 days (adjusted odds ratio [aOR], 2.394; 95% confidence interval [95% CI], 1.172-4.892), severe pneumonia (aOR, 4.602; 95% CI, 1.154-18.353), and poor response to the stepwise approach for MP pneumonia (aOR, 4.354; 95% CI, 1.374-13.800). In addition, higher levels of liver enzymes and lactate dehydrogenase at admission were associated with respiratory virus coinfection in children with MP pneumonia. CONCLUSIONS The results of this study suggest that respiratory virus coinfection in children hospitalized with MP pneumonia may be associated with refractory MP pneumonia.
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Affiliation(s)
- Soojeong Choo
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Choo S, Kim SH, Lee E. Clinical significance of Mycoplasma pneumoniae specific IgM titer in children hospitalized with Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2022; 22:470. [PMID: 35578177 PMCID: PMC9109195 DOI: 10.1186/s12879-022-07456-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The present study aimed to identify the clinical significance of Mycoplasma pneumoniae (MP)-specific immunoglobulin M (IgM) titer, in addition to a diagnosis of MP infection, in children with MP pneumonia. METHODS This study was performed in 155 children hospitalized with MP pneumonia. The clinical features and laboratory and radiographic findings on admission in children with positive or negative MP-specific IgM titers were retrospectively reviewed from the electronic medical records. RESULTS The mean age of the included children was 6.0 years, and 118 (76.1%) of the children were positive for MP-specific IgM. A longer duration between symptom onset and admission (adjusted odds ratio [aOR] 1.47, 95% confidence interval [CI] 1.24-1.75), longer duration of symptoms during the illness (aOR 1.15, 95% CI 1.02-1.30), and development of extra-pulmonary manifestations (aOR 9.16, 95% CI 1.96-42.81) were significantly associated with a positive MP-specific IgM titer. Serum lactate dehydrogenase levels (aOR 1.00, 95% CI 1.00-1.01) and pneumonic infiltration involving > 50% of the total lung volume on chest radiography (aOR 4.68, 95% CI 1.12-19.55) were associated with positive MP-specific IgM in children with MP pneumonia. A poor response to stepwise treatment for MP pneumonia was more common in children with a positive MP-specific IgM titer than those with a negative MP-specific IgM titer on admission. CONCLUSIONS A positive MP-specific IgM titer at diagnosis of MP pneumonia may partially suggest an exaggerated immune response with a higher disease burden compared to children with MP pneumonia with a negative MP-specific IgM titer.
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Affiliation(s)
- Soojeong Choo
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Seo-Hee Kim
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Choi YJ, Chung EH, Lee E, Kim CH, Lee YJ, Kim HB, Kim BS, Kim HY, Cho Y, Seo JH, Sol IS, Sung M, Song DJ, Ahn YM, Oh HL, Yu J, Jung S, Lee KS, Lee JS, Jang GC, Jang YY, Chung HL, Choi SM, Han MY, Shim JY, Kim JT, Kim CK, Yang HJ, Suh DI. Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study. J Clin Med 2022; 11:jcm11020306. [PMID: 35054002 PMCID: PMC8779611 DOI: 10.3390/jcm11020306] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 02/04/2023] Open
Abstract
Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.
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Affiliation(s)
- Yun Jung Choi
- Hospital Medicine Center, Seoul National University Hospital, Seoul KS013, Korea;
- Department of Pediatrics, Seoul National University Hospital, Seoul KS013, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon KS015, Korea;
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju KS018, Korea;
| | - Chul-Hong Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon KS011, Korea; (C.-H.K.); (J.S.L.)
| | - Yong Ju Lee
- Department of Pediatrics, Yongin Severance Hospital, Yongin KS009, Korea;
| | - Hyo-Bin Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul KS013, Korea; (H.-B.K.); (C.-K.K.)
| | - Bong-Seong Kim
- Department of Pediatrics, Ulsan University Gangneung Asan Hospital, Gangneung KS007, Korea;
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan KS011, Korea; (H.Y.K.); (S.J.)
| | - Yoojung Cho
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul KS013, Korea;
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University Hospital, Dankook University Medical School, Cheonan KS002, Korea;
| | - In Suk Sol
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul KS013, Korea; (I.S.S.); (J.Y.S.)
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Gumi Hospital, Gumi KS010, Korea;
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul KS013, Korea;
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulju University, Seoul KS013, Korea;
| | - Hea Lin Oh
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul KS013, Korea;
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul KS013, Korea;
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan KS011, Korea; (H.Y.K.); (S.J.)
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri KS013, Korea;
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon KS011, Korea; (C.-H.K.); (J.S.L.)
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service, Ilsan Hospital, Goyang KS007, Korea;
| | - Yoon-Young Jang
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu KS002, Korea; (Y.-Y.J.); (H.L.C.)
| | - Hai Lee Chung
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu KS002, Korea; (Y.-Y.J.); (H.L.C.)
| | - Sung-Min Choi
- Department of Pediatrics, Dongguk University Gyeongju Hospital, Gyeongju KS010, Korea;
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam KS009, Korea;
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul KS013, Korea; (I.S.S.); (J.Y.S.)
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul KS013, Korea;
| | - Chang-Keun Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul KS013, Korea; (H.-B.K.); (C.-K.K.)
| | - Hyeon-Jong Yang
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul KS013, Korea;
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul KS013, Korea
- Correspondence: (H.-J.Y.); (D.I.S.); Tel.: +82-02-709-9114 (H.-J.Y.); +82-2-2072-7559 (D.I.S.)
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Seoul KS013, Korea
- Correspondence: (H.-J.Y.); (D.I.S.); Tel.: +82-02-709-9114 (H.-J.Y.); +82-2-2072-7559 (D.I.S.)
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Xu Q, Li L, Shen L, Huang X, Lu M, Hu C. Development and external validation of a simple nomogram for predicting apnea in children hospitalized with bronchiolitis. Front Pediatr 2022; 10:922226. [PMID: 36340712 PMCID: PMC9627176 DOI: 10.3389/fped.2022.922226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Apnea is one of the most life-threatening complications of bronchiolitis in children. This study aimed to determine early predictors of apnea in children hospitalized with bronchiolitis and develop a simple nomogram to identify patients at risk of apnea. METHODS This retrospective, observational study included children hospitalized with bronchiolitis in two hospitals in China. Demographic and clinical characteristics, laboratory results, pathogens, and pulmonary iconography results were recorded. A training cohort of 759 patients (one hospital) was used to identify early predictors of apnea during hospitalization. The least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection. The nomogram was developed visually based on the variables selected by multivariable logistic regression analysis. Discrimination (concordance index, C-index), calibration, and decision curve analysis (DCA) were used to assess the model performance and clinical effectiveness. RESULTS A total of 1,372 children hospitalized with bronchiolitis were retrospectively evaluated, 133 (9.69%) of whom had apnea. Apnea was observed in 80 of the 759 patients with bronchiolitis in the training cohort and 53 of the 613 patients in the external validation cohort. Underlying diseases, feeding difficulties, tachypnea, retractions and pulmonary atelectasis in the training cohort were independent risk factors for apnea and were assembled into the nomogram. The nomogram exhibited good discrimination with a C-index of 0.883 (95% CI: 0.839-0.927) and good calibration. The DCA showed that the nomogram was clinically useful in estimating the net benefit to patients. CONCLUSION We developed a nomogram that is convenient to use and able to identify the individualized prediction of apnea risk in patients with bronchiolitis. These patients might benefit from early triage and more intensive monitoring.
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Affiliation(s)
- Qiuyan Xu
- Department of Pediatrics, Suzhou Science / Technology Town Hospital, Suzhou, China
| | - Linlin Li
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Li Shen
- Department of Pharmacy, Suzhou Science / Technology Town Hospital, Suzhou, China
| | - Xia Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Min Lu
- Department of Pediatrics, Suzhou Science / Technology Town Hospital, Suzhou, China
| | - Chunxia Hu
- Department of Respiratory Medicine, Children's Hospital of Wujiang District, Children's Hospital of Soochow University, Suzhou, China
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Chen J, Qi X, Yin Y, Zhang L, Zhang J, Yuan S. Effects of minocycline on macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a single-center retrospective study. Transl Pediatr 2021; 10:2997-3004. [PMID: 34976765 PMCID: PMC8649588 DOI: 10.21037/tp-21-356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Macrolide-resistant Mycoplasma pneumoniae (Mp) has become widespread in the world. We sought to determine the independently associated risk factors for refractory Mp pneumonia among macrolide-unresponsive Mp pneumonia children treated with minocycline and to investigate the effects of minocycline against macrolide-unresponsive Mp pneumonia. METHODS In our center, we retrospectively analyzed the data of hospitalized macrolide-unresponsive Mp pneumonia patients aged ≤18 years old who changed macrolide therapies to minocycline treatments between March 2013 and September 2018. Patient characteristics and defervescence after minocycline treatment were compared between refractory Mp pneumonia and non-refractory Mp pneumonia groups. Multivariable logistic regression analysis was performed among these macrolide-unresponsive Mp pneumonia patients. RESULTS Among 150 included macrolide-unresponsive Mp pneumonia children treated with minocycline; 30 cases (20.0%) were refractory Mp pneumonia. Duration of macrolide treatment before administration of minocycline (odds ratio =2.87, 95% CI: 1.79-4.61, P<0.001) and serum procalcitonin levels (odds ratio =13.50, 95% CI: 1.22-149.57, P=0.034) were independently associated with refractory Mp pneumonia. Defervescence after minocycline treatment was significantly longer among the refractory Mp pneumonia group than in the non-refractory Mp pneumonia group (median 2 vs. 1 day, P<0.001). Only one case (0.7%) suspected of a side effect of minocycline therapy was observed. CONCLUSIONS Two risk factors independently associated with refractory Mp pneumonia were determined. Early use of minocycline might safely prevent macrolide-unresponsive Mp pneumonia from progressing to refractory Mp pneumonia.
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Affiliation(s)
- Jiande Chen
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinyi Qi
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhua Yuan
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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黄 丽, 黄 冬, 鲁 灵, 黎 静, 彭 淑. [Value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid for predicting refractory Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:471-474. [PMID: 34020736 PMCID: PMC8140331 DOI: 10.7499/j.issn.1008-8830.2012095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid (BALF) for predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. METHODS A total of 50 children with common Mycoplasma pneumoniae pneumonia (MPP) and 22 children with RMPP were enrolled. The two groups were compared in terms of clinical features, laboratory examination results, imaging findings, and YKL-40 levels in BALF. The receiver operating characteristic (ROC) curve was used to evaluate the value of YKL-40 in BALF for predicting RMPP. RESULTS Compared with the common MPP group, the RMPP group had significantly higher incidence rates of fever, shortness of breath, lung consolidation, and pleural effusion (P < 0.05) and significantly higher serum levels of C-reactive protein and lactate dehydrogenase (P < 0.05). The RMPP group had a significantly higher level of YKL-40 in BALF than the common MPP group (P < 0.05). The ROC curve plotted based on the level of YKL-40 in BALF had an area under the ROC curve of 0.750, a sensitivity of 72.7% and a specificity of 64.0% for predicting RMPP. CONCLUSIONS There is an increase in the level of YKL-40 in BALF in children with RMPP, and the level of YKL-40 in BALF has a certain value for predicting RMPP.
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Affiliation(s)
- 丽林 黄
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 冬平 黄
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 灵龙 鲁
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 静 黎
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 淑梅 彭
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
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Bi Y, Zhu Y, Ma X, Xu J, Guo Y, Huang T, Zhang S, Wang X, Zhao D, Liu F. Development of a scale for early prediction of refractory Mycoplasma pneumoniae pneumonia in hospitalized children. Sci Rep 2021; 11:6595. [PMID: 33758243 PMCID: PMC7987979 DOI: 10.1038/s41598-021-86086-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/09/2021] [Indexed: 12/25/2022] Open
Abstract
Now there is no clinical scale for early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP). The aim of this study is to identify indicators and develop an early predictive scale for RMPP in hospitalized children. First we conducted a retrospective cohort study of children with M. pneumoniae pneumonia admitted to Children's Hospital of Nanjing Medical University, China in 2016. Children were divided into two groups, according to whether their pneumonia were refractory and the results were used to develop an early predictive scale. Second we conducted a prospective study to validate the predictive scale for RMPP in children in 2018. 618 children were included in the retrospective study, of which 73 with RMPP. Six prognostic indicators were identified and included in the prognostic assessment scale. The sensitivity of the prognostic assessment scale was 74.0% (54/73), and the specificity was 88.3% (481/545) in the retrospective study. 944 children were included in the prospective cohort, including 92 with RMPP, the sensitivity of the prognostic assessment scale was 78.3% (72/92) and the specificity was 86.2% (734/852). The prognostic assessment scale for RMPP has high diagnostic accuracy and is suitable for use in standard clinical practice.
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Affiliation(s)
- Ying Bi
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
- Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, China
| | - Yifan Zhu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Xiao Ma
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Jiejing Xu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
- Department of Pediatrics, The Second People's Hospital of Changzhou, Affiliate Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Yun Guo
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
- Department of Respiratory Medicine, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, China
| | - Tianyu Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Siqing Zhang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Xin Wang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China.
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China.
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Wen J, Su Y, Sun H, Zhang H, Li H. The combination of initial markers to predict refractory Mycoplasma pneumoniae pneumonia in Chinese children: a case control study. Respir Res 2021; 22:89. [PMID: 33752670 PMCID: PMC7983087 DOI: 10.1186/s12931-020-01577-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Objective Thise study is aimed to identify the biomarkers for predicting refractory Mycoplasma pneumoniae pneumonia in Chinese children at the time of the hospital admission. Methods The case control study retrospectively analyzed the clinical characteristics and laboratory results of Chinese pediatric patients presenting with common and refractory Mycoplasma pneumoniae pneumonia (CMPP and RMPP). Overall, there were 216 cases in the CMPP group and 88 cases in the RMPP group. Venous blood was collected, and serum ferritin (SF), lactate dehydrogenase (LDH), D-dimer, C-reactive protein (CRP), procalcitonin (PCT), neutrophil count/lymphocyte count (NLR), and other indexes were measured. A single factor analysis, an ROC curve analysis, and a logistic regression analysis were used to determine the independent risk factors of RMPP and find combination of initial markers for RMPP. Results There were significant differences between the RMPP group and the CMPP group in mean SF (529.82 [357.86] vs. 147.22 [122.68] ng/mL), LDH (522.08 [389.08] vs. 286.85 [101.02] U/L), D-dimer (6.65 [5.66] vs. 1.46 [2.45] μg/mL), CRP (62.80 [52.15] vs. 19.03 [24.50] mg/L), PCT (0.80 [2.61] vs. 0.16 [0.44]) ng/mL, and NLR (4.14 [2.52] vs. 2.62 [1.55]), with P < 0.05 for each comparison. ROC cut-off values of the above indexes were 329.01 ng/mL, 375.50 U/L, 2.10 μg/mL, 43.08 mg/L, 0.08 ng/mL, and 2.96, respectively. The logistic regression analysis showed that SF, D-dimer, and CRP are independent risk factors to predict RMPP. Conclusion SF, D-dimer, and CRP are statistically significant biomarkers to predict RMPP in Chinese children patients in the settings of pediatric emergency department.
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Affiliation(s)
- Jun Wen
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, No. 227, Yanta West Road, Yanta district, Xi'an, Shaanxi, 86-710061, People's Republic of China.,Department of Emergency, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710061, People's Republic of China
| | - Yufei Su
- Department of Emergency, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710061, People's Republic of China
| | - Hongli Sun
- Shaanxi Institute for Pediatric Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710003, People's Republic of China
| | - Huiping Zhang
- Department of Neonatology, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710003, People's Republic of China
| | - Hui Li
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, No. 227, Yanta West Road, Yanta district, Xi'an, Shaanxi, 86-710061, People's Republic of China. .,Department of Neonatology, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710003, People's Republic of China.
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