Dataset Information

Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia.

ABSTRACT: The presence of bronchial mucus plugs (BMP) in children with Mycoplasma pneumoniae pneumonia (MPP) results in delayed clinical and radiographic resolution and long-standing pulmonary sequelae. The predictive factors associated with BMP formation remains poorly defined. Nomograms to predict BMP presence in children with MPP were proposed using a cohort of patients who underwent bronchoscopy intervention at Children's Hospital in Eastern China. Patients with MPP in an earlier period formed the training cohort (n?=?872) for nomogram development, and those thereafter formed the validation cohort (n?=?399) to confirmed model's performance. BMP in children with MPP were found in 196 (22.5%) and 91(22.8%) patients in the training and validation cohorts, respectively. The independent risk factors associated with BMP were age >5years (OR 2.06; 95% CI 1.43 to 2.98), higher IL-10 level (>10?ng/L, 2.19; 95% CI 1.46 to 3.28), higher IFN-? level (>30?ng/L, 1.69; 95% CI 1.13 to 2.54), and presence of complication (3.43; 95% CI 1.45 to 8.09). Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.771(95% CI, 0.734-0.808) and 0.796 (95% CI, 0.744-0.848) in predicting BMP in the training and validation cohorts, respectively. The nomogram achieved an optimal prediction of BMP in children with MPP. Using this model, the risk of BMP formation would be determined, contributing to a rational therapeutic choice.

SUBMITTER: Xu X

PROVIDER: S-EPMC7067858 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia.

Xu Xuefeng X Li Huiwen H Sheng Yuanjian Y Wu Lei L Wang Danli D Liu Lingyue L Tong Yu Y Chen Zhimin Z

Scientific reports 20200312 1

The presence of bronchial mucus plugs (BMP) in children with Mycoplasma pneumoniae pneumonia (MPP) results in delayed clinical and radiographic resolution and long-standing pulmonary sequelae. The predictive factors associated with BMP formation remains poorly defined. Nomograms to predict BMP presence in children with MPP were proposed using a cohort of patients who underwent bronchoscopy intervention at Children's Hospital in Eastern China. Patients with MPP in an earlier period formed the tra ...[more]

PMID: 32165709

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Project description:BackgroudThe 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.MethodsA 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).ResultsMultivariate 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.ConclusionThis 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.

Project description:BackgroundRefractory 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.MethodsWe 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.ResultsThe 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.ConclusionsThe simple and easy-to-use nomogram can help clinicians, especially primary doctors, to make early diagnoses of RMPP.

Project description:BackgroundThe relationship between vitamin D nutritional status and the formation of bronchial mucus plugs (BMPs) is unclear. The aims of the current study were to investigate associations between serum 25(OH)D levels, serum inflammatory factors, and clinical characteristics in children with mycoplasma pneumonia (MPP), and to summarize the risk factors for BMPs in children with MPP.MethodsClinical data from 175 children with MPP were collected and analyzed, the children were divided into a BMP group and a non-BMP group. Serum 25(OH)D levels, IL-8, and various inflammatory factors were compared in the two groups. Associations between 25(OH)D levels and IL-8, various inflammatory factors, and clinical characteristics were analyzed, and the diagnostic value of serum 25(OH)D levels was assessed.ResultsSerum 25(OH)D level was significantly lower in the BMP group (p < 0.05). Serum IL-8 level, percentages of neutrophils, and some inflammatory factors were significantly higher in the BMP group (p < 0.05). Serum 25(OH)D level was negatively correlated with IL-8, neutrophil percentage, various inflammatory factors (all p < 0.05). It was also associated with lobular infection, pleural effusion, mechanical ventilation, and mycoplasma 2,063/2,064 mutation (all p < 0.05). In multivariate regression analysis 25(OH)D [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.97-0.99, p = 0.003], IL-8 (OR 1.02, 95% CI 1.00-1.04, p = 0.002), polylobular infection (OR 1.75, 95% CI 1.17-2.64, p = 0.007), and MP DNA copies (OR 0.98, 95% CI 1.04-1.01, p = 0.022) were independent risk factors for BMPs, and the area under the curve value was 0.915 (95% CI 0.895-0.935). If the serum 25(OH)D level was <50 nmol/L, the respective percentages for sensitivity, specificity, positive predictive value, and negative predictive value were 97, 81, 78.9, and 97.6%.ConclusionsVitamin D deficiency is common in children with MPP, and 25(OH)D levels are closely associated with inflammatory factors and disease severity in children. The serum 25 (OH) D level of MPP children with BMPs was lower than that of children without BMPs. Serum 25(OH)D can be used as a marker for the diagnosis of MPP in children with BMPs.

Project description:BackgroundMycoplasma pneumoniae (M. pneumoniae) is an important pathogen of community-acquired pneumonia in children. The factors contributing to the severity of illness caused by M. pneumoniae infection are still under investigation. We aimed to evaluate the sensitivity of common M. pneumoniae detection methods, as well as to analyze the clinical manifestations, genotypes, macrolide resistance, respiratory microenvironment, and their relationship with the severity of illness in children with M. pneumoniae pneumonia in Wuhan.ResultsAmong 1,259 clinical samples, 461 samples were positive for M. pneumoniae via quantitative polymerase chain reaction (qPCR). Furthermore, we found that while serological testing is not highly sensitive in detecting M. pneumoniae infection, but it may serve as an indicator for predicting severe cases. We successfully identified the adhesin P1 (P1) genotypes of 127 samples based on metagenomic and Sanger sequencing, with P1-type 1 (113/127, 88.98%) being the dominant genotype. No significant difference in pathogenicity was observed among different genotypes. The macrolide resistance rate of M. pneumoniae isolates was 96% (48/50) and all mutations were A2063G in domain V of 23S rRNA gene. There was no significant difference between the upper respiratory microbiome of patients with mild and severe symptoms.ConclusionsDuring the period of this study, the main circulating M. pneumoniae was P1-type 1, with a resistance rate of 96%. Key findings include the efficacy of qPCR in detecting M. pneumoniae, the potential of IgM titers exceeding 1:160 as indicators for illness severity, and the lack of a direct correlation between disease severity and genotypic characteristics or respiratory microenvironment. This study is the first to characterize the epidemic and genomic features of M. pneumoniae in Wuhan after the COVID-19 outbreak in 2020, which provides a scientific data basis for monitoring and infection prevention and control of M. pneumoniae in the post-pandemic era.

Dataset Information

Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia.

Publications

Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia.

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