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Abstract：
UNASSIGNED: Refractory Mycoplasma pneumoniae pneumonia (RMPP) has a serious, rapid progression that can easily cause a variety of extra-pulmonary complications. Therefore, the early identification of RMPP is crucial. This study aimed to construct and validate a risk prediction model based on clinical manifestations, laboratory blood indicators, and radiological findings to help clinicians identify patients who are at high risk of RMPP.
UNASSIGNED: We retrospectively analyzed the medical records of 369 children with Mycoplasma pneumoniae pneumonia (MPP) admitted to Xi\'an Children\'s Hospital, China. The demographics, clinical features, laboratory data, and radiological findings between the RMPP group and the general Mycoplasma pneumoniae pneumonia (GMPP) group were compared and subjected to univariate and multivariate logistic regression analyses.
UNASSIGNED: The fever peak and duration of the children in the RMPP group (n=86) were higher and longer compared with those in the GMPP group (n=283) (P<0.05). There was a significant difference in the incidence of lobar pneumonia and pleural effusion in pulmonary imaging between the two groups (P<0.05). Laboratory tests showed that the children with RMPP had lower serum uric acid (SUA) and albumin (ALB) as compared with the GMPP group (P<0.05). White blood cells (WBCs), neutrophil count (NEP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) were higher in the RMPP group (P<0.05). Binary logistic regression analysis showed that the fever duration, pleural effusion, WBC, NEP, lactate dehydrogenase (LDH), CRP, NLR, and SUA levels were independent predictors of RMPP (P<0.05). The receiver operator characteristic (ROC) curve results showed fever duration, WBC, NEP, CRP, LDH, SUA, and NLR had good predictive value. The areas under the curve (AUCs) were 0.861, 0.730, 0.758, 0.837, 0.868, 0.744, and 0.713 and the best cutoff values were 10.50, 10.13, 6.43, 29.45, 370.50, 170.50, and 3.47, respectively. Finally, fever duration of more than 10.5 days, pleural effusion, WBC >10.13×109/L, NEP >6.43×109/L, CRP >29.45 mg/L, LDH >370.50 U/L, NLR >3.47, and SUA <170.5 µmol/mL constructed a prediction model of RMPP. According to internal validation, the mean AUC of the nomogram based on the development dataset was 0.956 [95% confidence interval (CI): 0.937-0.974] with good discrimination ability for predicting RMPP patients. The calibration plot and Hosmer-Lemeshow test (P=0.70) of the prediction model showed good consistency between the predicted probability and actual probability. Decision curve analysis (DCA) showed that the nomogram is clinically useful.
UNASSIGNED: The simple and easy-to-use nomogram can help clinicians, especially primary doctors, to make early diagnoses of RMPP.
UNASSIGNED: We retrospectively analyzed the medical records of 369 children with Mycoplasma pneumoniae pneumonia (MPP) admitted to Xi\'an Children\'s Hospital, China. The demographics, clinical features, laboratory data, and radiological findings between the RMPP group and the general Mycoplasma pneumoniae pneumonia (GMPP) group were compared and subjected to univariate and multivariate logistic regression analyses.
UNASSIGNED: The fever peak and duration of the children in the RMPP group (n=86) were higher and longer compared with those in the GMPP group (n=283) (P<0.05). There was a significant difference in the incidence of lobar pneumonia and pleural effusion in pulmonary imaging between the two groups (P<0.05). Laboratory tests showed that the children with RMPP had lower serum uric acid (SUA) and albumin (ALB) as compared with the GMPP group (P<0.05). White blood cells (WBCs), neutrophil count (NEP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) were higher in the RMPP group (P<0.05). Binary logistic regression analysis showed that the fever duration, pleural effusion, WBC, NEP, lactate dehydrogenase (LDH), CRP, NLR, and SUA levels were independent predictors of RMPP (P<0.05). The receiver operator characteristic (ROC) curve results showed fever duration, WBC, NEP, CRP, LDH, SUA, and NLR had good predictive value. The areas under the curve (AUCs) were 0.861, 0.730, 0.758, 0.837, 0.868, 0.744, and 0.713 and the best cutoff values were 10.50, 10.13, 6.43, 29.45, 370.50, 170.50, and 3.47, respectively. Finally, fever duration of more than 10.5 days, pleural effusion, WBC >10.13×109/L, NEP >6.43×109/L, CRP >29.45 mg/L, LDH >370.50 U/L, NLR >3.47, and SUA <170.5 µmol/mL constructed a prediction model of RMPP. According to internal validation, the mean AUC of the nomogram based on the development dataset was 0.956 [95% confidence interval (CI): 0.937-0.974] with good discrimination ability for predicting RMPP patients. The calibration plot and Hosmer-Lemeshow test (P=0.70) of the prediction model showed good consistency between the predicted probability and actual probability. Decision curve analysis (DCA) showed that the nomogram is clinically useful.
UNASSIGNED: The simple and easy-to-use nomogram can help clinicians, especially primary doctors, to make early diagnoses of RMPP.
摘要：
■难治性肺炎支原体肺炎(RMPP)有严重的,快速进展，容易引起各种肺外并发症。因此,RMPP的早期识别至关重要。本研究旨在构建并验证基于临床表现的风险预测模型,实验室血液指标，和放射学检查结果，以帮助临床医生识别RMPP高危患者。
我们回顾性分析了西安市儿童医院收治的369例肺炎支原体肺炎（MPP）患儿的病历，中国。人口统计，临床特征,实验室数据,比较RMPP组和普通肺炎支原体肺炎（GMPP）组之间的放射学结果，并进行单因素和多因素logistic回归分析。
■与GMPP组（n=283）相比，RMPP组（n=86）患儿的发热高峰和持续时间更高（P<0.05）。两组肺部影像学检查大叶性肺炎和胸腔积液发生率比较,差异有统计学意义(P<0.05)。实验室检测显示，RMPP患儿的血清尿酸（SUA）和白蛋白（ALB）均低于GMPP组（P<0.05）。白细胞（WBC），中性粒细胞计数（NEP），红细胞沉降率（ESR），降钙素原(PCT),C反应蛋白(CRP),RMPP组中性粒细胞与淋巴细胞比值（NLR）较高（P<0.05）。二元logistic回归分析显示，发热持续时间，胸腔积液,WBC,NEP,乳酸脱氢酶（LDH），CRP,NLR,SUA水平是RMPP的独立预测因子(P<0.05)。受试者操作特征(ROC)曲线结果显示发热持续时间,WBC,NEP,CRP,LDH,SUA,NLR具有良好的预测价值。曲线下面积（AUC）分别为0.861、0.730、0.758、0.837、0.868、0.744和0.713，最佳临界值分别为10.50、10.13、6.43、29.45、370.50、170.50和3.47。最后,发烧持续时间超过10.5天，胸腔积液,WBC>10.13×109/L,NEP>6.43×109/L,CRP>29.45mg/L，LDH>370.50U/L,NLR>3.47，SUA<170.5μmol/mL构建了RMPP的预测模型。根据内部验证,基于发展数据集的列线图的平均AUC为0.956[95%置信区间(CI):0.937-0.974],对于预测RMPP患者具有良好的辨别能力.预测模型的校准图和Hosmer-Lemeshow检验（P=0.70）显示出预测概率与实际概率之间的良好一致性。决策曲线分析（DCA）显示列线图在临床上有用。
■简单易用的列线图可以帮助临床医生，尤其是初级医生，对RMPP进行早期诊断。
我们回顾性分析了西安市儿童医院收治的369例肺炎支原体肺炎（MPP）患儿的病历，中国。人口统计，临床特征,实验室数据,比较RMPP组和普通肺炎支原体肺炎（GMPP）组之间的放射学结果，并进行单因素和多因素logistic回归分析。
■与GMPP组（n=283）相比，RMPP组（n=86）患儿的发热高峰和持续时间更高（P<0.05）。两组肺部影像学检查大叶性肺炎和胸腔积液发生率比较,差异有统计学意义(P<0.05)。实验室检测显示，RMPP患儿的血清尿酸（SUA）和白蛋白（ALB）均低于GMPP组（P<0.05）。白细胞（WBC），中性粒细胞计数（NEP），红细胞沉降率（ESR），降钙素原(PCT),C反应蛋白(CRP),RMPP组中性粒细胞与淋巴细胞比值（NLR）较高（P<0.05）。二元logistic回归分析显示，发热持续时间，胸腔积液,WBC,NEP,乳酸脱氢酶（LDH），CRP,NLR,SUA水平是RMPP的独立预测因子(P<0.05)。受试者操作特征(ROC)曲线结果显示发热持续时间,WBC,NEP,CRP,LDH,SUA,NLR具有良好的预测价值。曲线下面积（AUC）分别为0.861、0.730、0.758、0.837、0.868、0.744和0.713，最佳临界值分别为10.50、10.13、6.43、29.45、370.50、170.50和3.47。最后,发烧持续时间超过10.5天，胸腔积液,WBC>10.13×109/L,NEP>6.43×109/L,CRP>29.45mg/L，LDH>370.50U/L,NLR>3.47，SUA<170.5μmol/mL构建了RMPP的预测模型。根据内部验证,基于发展数据集的列线图的平均AUC为0.956[95%置信区间(CI):0.937-0.974],对于预测RMPP患者具有良好的辨别能力.预测模型的校准图和Hosmer-Lemeshow检验（P=0.70）显示出预测概率与实际概率之间的良好一致性。决策曲线分析（DCA）显示列线图在临床上有用。
■简单易用的列线图可以帮助临床医生，尤其是初级医生，对RMPP进行早期诊断。
