title: Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults.
abstract: Serum interleukin (IL)-18 level was thought to be a useful as a predictor of refractory or severe Mycoplasma pneumoniae pneumonia, and steroid administration is reported to be effective in this situation. The serum levels of IL-18 correlated significantly with those of lactate dehydrogenase (LDH). The purpose of this study was to set a standard for the initiation of steroid therapy in M. pneumoniae pneumonia using a simple serum marker. We analyzed 41 adolescent and adult patients with refractory or severe M. pneumoniae pneumonia who received steroid therapy, and compared them with 108 patients with M. pneumoniae pneumonia who responded to treatment promptly (control group). Serum LDH levels were significantly higher in the refractory and severe group than in the control group at the initiation of steroid therapy (723 vs 210 IU/L, respectively; p < 0.0001). From receiver operating characteristic curve analysis, we calculated serum LDH cut-off levels of 364 IU/L at initiation of steroid therapy and 302 IU/L at 1-3 days before the initiation of steroid therapy. The administration of steroids to patients in the refractory and severe group resulted in the rapid improvement of symptoms and a decrease in serum LDH levels in all patients. Serum LDH level can be used as a useful parameter to determine the initiation of steroid therapy in refractory or severe M. pneumoniae pneumonia. A serum LDH level of 302-364 IU/L seems to be an appropriate criterion for the initiation of steroid therapy.
authors.affiliation: Department of Internal Medicine 1, Kawasaki Medical School, Okayama, Japan. Electronic address: nao@med.kawasaki-m.ac.jp.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miyashita
authors.affiliation: Department of Internal Medicine 1, Kawasaki Medical School, Okayama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Norikazu
authors.initials: N
authors.lastname: Inamura
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Akaike
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Teranishi
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Tokio
authors.initials: T
authors.lastname: Wakabayashi
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Ouchi
authors.affiliation: Department of Internal Medicine 1, Kawasaki Medical School, Okayama, Japan.
authors.forename: Niro
authors.initials: N
authors.lastname: Okimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000097:blood; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009177:Mycoplasma pneumoniae / Q000472:pathogenicity*; D011019:Pneumonia, Mycoplasma / Q000097:blood / Q000188:drug therapy*; D013256:Steroids / Q000592:standards / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020382:Interleukin-18; D013256:Steroids; D007770:L-Lactate Dehydrogenase
keywords: Interleukin 18; Lactate dehydrogenase; Mycoplasma pneumoniae; Refractory pneumonia; Severe pneumonia; Steroid therapy