title: The Clinical Characteristics and Predictors of Refractory Mycoplasma pneumoniae Pneumonia in Children.
abstract: OBJECTIVE
  To analyze the clinical characteristics of refracory Mycoplasma pneumoniae pneumonia (RMPP), and explore the related factors predicting RMPP.
  
  
  METHODS
  Retrospective analysis was performed on 634 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our hospital between January 1, 2011 and December 31, 2014. The clinical features, laboratory data, radiological findings between the RMPP group and the general Mycoplasma pneumoniae pneumonia (GMPP) group were compared and the predictive values of related factors were analyzed.
  
  
  RESULTS
  The median age of the RMPP patients (n = 145) was much older than that of the GMPP patients (n = 489) (P<0.01). We also found more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings in RMPP group, which needed oxygen more often, longer antibiotics administration and intensive care (P<0.05). Meanwhile, the levels of C-reactive protein (CRP), lactic dehydrogenase (LDH), immunoglobulin A (IgM), interleukin (IL)-6, IL-10, interferon gamma (IFN-γ) and the percentage of neutrophils, CD8+ in RMPP group were significantly higher than those in GMPP group (P<0.05); while the levels of prealbumin (PAB) were lower than that in GMPP group (P<0.01). In ROC curve analysis, the percentage of neutrophil, CRP, LDH, PAB, IL-6, IL-10 and IFN-γ were useful for differentiating patients with RMPP from those with GMPP. Multiple logistic regression analysis showed that the CRP≥16.5mg/L, LDH ≥417IU/L and IL-6 ≥14.75pg/ml were significant predictors regarding to RMPP.
  
  
  CONCLUSIONS
  CRP≥16.5mg/L, LDH ≥417IU/L and IL-6 ≥14.75pg/ml might be the significant predictors of RMPP in children, which can aid in early recognition of RMPP.
authors.affiliation: Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Yunlian
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Shuxian
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Dehua
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Xiling
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Chen
mesh_terms: D017668:Age of Onset; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D009177:Mycoplasma pneumoniae; D011019:Pneumonia, Mycoplasma / Q000097:blood / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D016207:Cytokines; D007070:Immunoglobulin A; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase