Analysis On The Risk Factors Of Mycoplasma Pneumoniae Necrotizing Pneumonia In Children

Objective:To analyze the risk factors of Mycoplasma pneumoniae necrotizing pneumonia(MPNP)in children,so as to identify and diagnose MPNP early and improve the prognosis of MPNP.Methods:1.A retrospective study was conducted to collect children admitted to the Respiratory Department of Shanxi Children’s Hospital from January 2021 to December 2022 who were diagnosed with severe mycoplasma pneumoniae pneumonia(SMPP).The children were divided into MPNP group(50 cases)and non-MPNP group(101 cases).2.The related data of the children were collected,including: general data,laboratory indexes,chest CT,bronchoscopy findings and treatment.3.The indicators with statistically significant differences in univariate analysis were used for multivariate Logistic regression analysis to obtain the independent risk factors of MPNP.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of the independent risk factors in the diagnosis of MPNP.Results:1.There was no significant difference in gender composition and age distribution between MPNP group and non-MPNP group(P>0.05).The course of disease before admission,fever time and hospitalization time in MPNP group were longer than those in non-MPNP group,and the differences were statistically significant(P<0.05).2.The white blood cell count,percentage of neutrophils,C-reactive protein,erythrocyte sedimentation rate,procalcitonin,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,D-dimer levels in MPNP group were higher than those in non-MPNP group,and the total protein,albumin,and prealbumin were lower than those in non-MPNP group,and the differences were statistically significant(P<0.05).3.The proportion of patients with pleural effusion,pleural thickening,rice-water-like turbidity of bronchoalveolar lavage fluid,and the use of other antibiotics and low molecular weight heparin calcium in the MPNP group was higher than that in the non-MPNP group,and the bronchoscopic intervention time in MPNP group was longer than that in non-MPNP group,the difference was statistically significant(P<0.05).4.Multivariate Logistic regression analysis showed that,Higher white blood cell count [OR(95%CI)=1.474(1.236~1.756)],D-dimer [OR(95%CI)=1.320(1.163~1.498)],and rice-water-like turbidity of bronchoalveolar lavage fluid [ OR(95%CI)=11.832(2.312~60.556)was an independent risk factor for MPNP(P<0.05),and a higher level of prealbumin [OR(95%CI)=0.981(0.968~0.994)] was a protective factor against MPNP(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that white blood cell count,D-dimer,and prealbumin had application value in the diagnosis of MPNP in children(P<0.05),and the cut-off values were 10.17×109/L,2.35mg/L,and 94.00mg/L,respectively.The combination of the three indicators could further improve the diagnostic performance [AUC(95%CI)=0.932(0.886~0.979)],and the sensitivity and specificity were 0.920 and 0.851,respectively.Conclusions:White blood cell count,D-dimer,prealbumin,and rice-water-like turbidity ofbronchoalveolar lavage fluid are independent risk factors for MPNP in children with SMPP.MPNP should be considered when white blood cell count >10.17×109/L,D-dimer >2.35mg/L,prealbumin <94.00mg/L,and rice-water-like turbidity of bronchoalveolar lavage fluid by bronchoscopy.Clinical examination should be further improved to clarify the condition,and early intervention should be carried out to improve the prognosis of children.