Construction of a risk nomograph model for plastic bronchitis caused by refractory mycoplasma pneumoniae pneumonia in children

doi:10.3877/cma.j.issn.1674-1358.2023.04.009

Abstract

Abstract:

Objective

To investigate the incidence and main risk factors of plastic bronchitis (PB) caused by refractory Mycoplasma pneumoniae pneumonia (RMPP) in children, and to construct a quantitative risk nomograph model for guiding early clinical high-risk stratification.

Methods

The clinical data of 350 children diagnosed as RMPP admitted to Jianhu Clinical Medical College, Yangzhou University from February 2020 to February 2023 were analyzed, retrospectively, and were divided into modeling set (280 cases) and validation set (70 cases) by 4︰1, randomly. The model set was divided into PB group (120 cases) and no PB group (160 cases) according to bronchofiberscopy and histopathological findings. The clinical manifestations, blood biochemistry and chest CT signs of patients in different groups were compared, the most different indicators were screened by LASSO regression, the main risk factors were screened by multivariate Logistic regression, and the prediction model was drawn by histogram. The area under the curve (AUC) of plastic bronchitis was predicted by receiver operating curve (ROC) calculation model. The goodness of fit of the model was evaluated by Hosmer-Lemeshow test. The consistency and benefit of the model were evaluated by calibration curve and decision curve.

Results

The modeling set diagnosed 120 cases of PB (42.9%, 120/280) and the verification set diagnosed 25 cases of PB (35.7%, 25/70). The positive rates of PB and other general clinical data were comparable between the two groups (all P > 0.05). Single-factor comparison showed that peak body temperature (t = 3.659, P = 0.001), fever duration (t = 5.021, P < 0.001), hypoxemia (χ² = 4.060, P = 0.044), glucocorticoid (χ² = 7.154, P = 0.007), intravenous gamma globulin (χ² = 16.169, P < 0.001), atelectasis (χ² = 13.810, P < 0.001), pleural effusion (χ² = 11.118, P < 0.001), neutrophil percentage (N%) (Z =1.659, P < 0.001), C-reactive protein (CRP) (Z =15.659, P < 0.001), procalcitonin (PCT) (Z = 9.654, P < 0.001), interleukin 6 (IL-6) (Z = 23.324, P < 0.001), alanine aminotransferase (ALT) (Z = 3.425, P < 0.001), lactate dehydrogenase (LDH) (Z = 123.325, P < 0.001) and D-dimer (Z = 5.246, P < 0.001) were significantly higher than those without PB, while platelet count (PLT) was significantly decreased (Z = 1.995, P < 0.001). Total of 6 non-collinear indexes were selected by LASSO regression, namely peak body temperature, atelectasis, pleural effusion, N%, IL-6 and LDH. Multivariate Logistic regression showed that peak body temperature (OR = 2.756, 95%CI: 2.03-3.567, P < 0.001), atelectasis (OR = 3.526, 95%CI: 2.869-4.123, P < 0.001), pleural effusion (OR = 2.032, 95%CI: 1.456-2.758, P < 0.001), N% (OR = 1.856, 95%CI: 1.235-2.632, P < 0.001), IL-6 (OR = 1.525, 95%CI: 1.124-2.201, P < 0.001), and LDH (OR = 1.302, 95%CI: 1.052-1.968, P < 0.001) were all the risk factors to PB caused by RMPP. The nomogram model was established by R software, with a total score of 500 points. The AUC of the model for predicting PB in model set and validation set were 0.902 (95%CI: 0.856-0.945, P < 0.001) and 0.866 (95%CI: 0.823-0.914, P < 0.001), respectively. Both the calibration curve and the decision curve showed that the model had good degree of coincidence and clinical net benefit ratio.

Conclusions

Children with RMPP have a high incidence of PB, peak body temperature, atelectasis, pleural effusion, N%, IL-6 and LDH are all main risk factors; a nomograph model was developed that has good potential for guiding clinical evaluation of high-risk PB and is worth promoting.

Key words: Mycoplasma pneumoniae pneumonia, Plastic bronchitis, Risk factor, Nomogram, Atelectasis, Pleural effusion, Interleukin 6, Lactate dehydrogenase

Mei Yang, Chun Zhou, Aihong Zhao, Qin Wang. Construction of a risk nomograph model for plastic bronchitis caused by refractory mycoplasma pneumoniae pneumonia in children[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(04): 274-281.

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References 25

[1]	Chang Q, Chen HL, Wu NS, et al. Prediction model for severe Mycoplasma pneumonia pneumonia in pediatric patients by admission laboratory indicators[J]. J Trop Pediatr,2022,68(4):123-125.
[2]	Bae E, Kim YJ, Kang HM, et al. Macrolide versus non-macrolide in combination with steroids for the treatment of lobar or segmental Mycoplasma pneumonia pneumonia unresponsive to initial macrolide monotherapy[J]. Antibiotics (Basel),2022,11(9):1233.
[3]	赵红杰，郭倩，田代印. 儿童塑型性支气管炎的临床预警因素分析[J]. 重庆医学,2022,51(17):2942-2944, 2950.
[4]	杨琴，鲍燕敏，易秋维, 等. 儿童流感合并塑型支气管炎的临床特征分析[J]. 中国当代儿科杂志,2020,22(2):106-111.
[5]	王定荣，黄璇，魏文, 等. 小儿肺炎支原体肺炎发生塑型支气管炎的危险因素分析[J]. 中国急救复苏与灾害医学杂志,2022,17(7):943-947.
[6]	Tong L, Huang S, Zheng C, et al. Refractory Mycoplasma pneumonia pneumonia in children: early recognition and management[J]. J Clin Med,2022,11(10):2824.
[7]	Liptzin DR, Mcgraw MD, Houin PR, et al. Fibrin airway cast obstruction: Experience, classification, and treatment guideline from Denver[J]. Pediatr Pulmonol,2022,57(2):529-537.
[8]	Lu S, Liu J, Cai Z, et al. Bronchial casts associated with Mycoplasma pneumoniae pneumonia in children[J]. J Int Med Res,2020,48(4):1023-1025.
[9]	Wang L, Wang W, Sun JM, et al. Efficacy of fiberoptic bronchoscopy and bronchoalveolar lavage in childhood-onset, complicated plastic bronchitis[J]. Pediatr Pulmonol,2020,55(11):3088-3095.
[10]	Yan Q, Niu W, Jiang W, et al. Risk factors for delayed radiographic resolution in children with refractory Mycoplasma pneumoniae pneumonia[J]. J Int Med Res,2021,49(5):654-656.
[11]	Zhang J, Wang T, Li R, et al. Prediction of risk factors of bronchial mucus plugs in children with Mycoplasma pneumoniae pneumonia[J]. BMC Infect Dis,2021,21(1):67.
[12]	Xu X, Li H, Sheng Y, et al. Nomogram for prediction of bronchial mucus plugs in children with Mycoplasma pneumoniae pneumonia[J]. Sci Rep,2020,10(1):4579.
[13]	Wang X, Zhong LJ, Chen ZM, et al. Necrotizing pneumonia caused by refractory Mycoplasma pneumonia pneumonia in children[J]. World J Pediatr,2018,14(4):344-349.
[14]	Cheng S, Lin J, Zheng X, et al. Development and validation of a simple-to-use nomogram for predicting refractory Mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol,2020,55(4):968-974.
[15]	张嵘，王婷，戴鸽, 等. 肺炎支原体感染致塑型性支气管炎的临床特征及危险因素分析[J]. 中华实用儿科临床杂志,2021,36(11):811-816.
[16]	Ling Y, Zhang T, Guo W, et al. Identify clinical factors related to Mycoplasma pneumoniae pneumonia with hypoxia in children[J]. BMC Infect Dis,2020,20(1):1-8.
[17]	杨雪，林荣军，金蓉, 等. 重症支原体肺炎患儿血小板参数测定的临床意义[J/CD]. 中华诊断学电子杂志,2022,6(1):37-40.
[18]	华军. 儿童难治性肺炎支原体肺炎发生塑型性支气管炎的危险因素分析[J]. 中华实用儿科临床杂志,2019,34(16):1219-1222.
[19]	Gong H, Sun B, Chen Y, et al. The risk factors of children acquiring refractory Mycoplasma pneumoniae pneumonia: a meta-analysis[J]. Medicine (Baltimore),2021,100(11): e24894.
[20]	郭靖，刘亚楠，郝明明, 等. 血清铁蛋白和乳酸脱氢酶在小儿难治性支原体肺炎外周血中的表达及与预后的相关性[J/CD]. 中华实验和临床感染病杂志(电子版),2020,14(2):133-137.
[21]	程欣，王碧航，赵先进. 肺炎支原体血清学标志物研究进展[J/CD]. 中华实验和临床感染病杂志(电子版),2019,13(4):265-268.
[22]	Patel N, Patel M, Inja R, et al. Plastic bronchitis in adult and pediatric patients: A review of its presentation, diagnosis, and treatment[J]. Mo Med,2021,118(4):363-373.
[23]	Ntiamoah P, Mukhopadhyay S, Ghosh S, et al. Recycling plastic: diagnosis and management of plastic bronchitis among adults[J]. Eur Respir Rev,2021,30(161):210096.
[24]	Mackie AS, Veldtman GR, Thorup L, et al. Plastic bronchitis and protein-losing enteropathy in the fontan patient: evolving understanding and emerging therapies[J]. Can J Cardiol,2022,38(7): 988-1001.
[25]	Xu Q, Zhang L, Hao C, et al. Prediction of bronchial mucus plugs formation in patients with refractory Mycoplasma pneumoniae pneumonia[J]. J Trop Pediatr,2017,63(2):148-154.

临床资料	建模集（280例）	验证集（70例）	统计量	P值
男/女（例）	146/134	39/31	χ² = 0.287	0.592
年龄（ ± s，岁）	6.8 ± 2.3	6.6 ± 2.2	t = 0.659	0.422
PB [例（%）]	120（42.9）	25（35.7）	χ² = 1.177	0.278
糖皮质激素[例（%）]	219（78.2）	51（72.9）	χ² = 0.911	0.340
IVIG [例（%）]	23（8.2）	5（7.1）	χ² = 0.087	0.768

临床资料	建模集（280例）	验证集（70例）	统计量	P值
男/女（例）	146/134	39/31	χ² = 0.287	0.592
年龄（ ± s，岁）	6.8 ± 2.3	6.6 ± 2.2	t = 0.659	0.422
PB [例（%）]	120（42.9）	25（35.7）	χ² = 1.177	0.278
糖皮质激素[例（%）]	219（78.2）	51（72.9）	χ² = 0.911	0.340
IVIG [例（%）]	23（8.2）	5（7.1）	χ² = 0.087	0.768

指标	无PB组（160例）	PB组（120例）	统计量	P值
男/女（例）	88/72	58/62	χ² = 1.221^a	0.269
年龄（ ± s，岁）	6.6 ± 2.1	6.9 ± 1.8	t = 1.032	0.238
峰值体温（ ± s，℃）	38.9 ± 1.2	40.9 ± 1.1	t = 3.659	0.001
发热持续时间（ ± s，d）	8.9 ± 2.2	9.8 ± 2.6	t = 5.021	< 0.001
低氧血症[例（%）]	16（10.0）	22（18.3）	χ² = 4.060^a	0.044
糖皮质激素[例（%）]	116（72.5）	103（85.8）	χ² = 7.154^a	0.007
IVIG [例（%）]	4（2.5）	19（15.8）	χ² = 16.169^a	< 0.001
肺不张[例（%）]	36（22.5）	52（43.3）	χ² = 13.810^a	< 0.001
胸腔积液[例（%）]	38（23.8）	51（42.5）	χ² = 11.118^a	0.001
WBC [M（P25，P75），× 10⁹/L）]	7.5（5.8，11.2）	7.8（6.2，13.4）	Z = 0.526	0.349
N% [M（P25，P75），%]	73.4（68.9，77.5）	78.5（70.2，83.6）	Z = 1.659	< 0.001
PLT [M（P25，P75），× 10⁹/L）]	279.8（232.3，332.6）	245.6（203.5，315.6）	Z = 1.995	< 0.001
CRP [M（P25，P75），mg/L]	19.9（11.2，32.2）	28.9（17.9，42.3）	Z = 15.659	< 0.001
PCT [M（P25，P75），ng/ml]	0.24（0.09，0.51）	0.45（0.29，0.66）	Z = 9.654	< 0.001
IL-6 [M（P25，P75），pg/ml]	30.2（19.8，55.6）	52.6（34.6，75.9）	Z = 23.324	< 0.001
ALT [M（P25，P75），U/L]	13.5（9.8，21.1）	18.9（11.2，25.6）	Z = 3.425	< 0.001
LDH [M（P25，P75），U/L]	356.9（246.5，552.3）	513.2（423.6，623.2）	Z = 123.325	< 0.001
APTT [M（P25，P75），s]	27.6（17.8，32.9）	29.5（20.2，35.6）	Z = 0.859	0.302
纤维蛋白原[M（P25，P75），g/L]	3.6（3.1，4.4）	3.8（3.3，4.6）	Z = 0.785	0.269
D-二聚体[M（P25，P75），mg/L]	0.13（0.08，0.42）	0.34（0.16，0.55）	Z = 5.246	< 0.001
IgE [M（P25，P75），IU/L]	114.5（100.5，149.8）	123.5（102.1，156.9）	Z = 1.096	0.124

指标	无PB组（160例）	PB组（120例）	统计量	P值
男/女（例）	88/72	58/62	χ² = 1.221^a	0.269
年龄（ ± s，岁）	6.6 ± 2.1	6.9 ± 1.8	t = 1.032	0.238
峰值体温（ ± s，℃）	38.9 ± 1.2	40.9 ± 1.1	t = 3.659	0.001
发热持续时间（ ± s，d）	8.9 ± 2.2	9.8 ± 2.6	t = 5.021	< 0.001
低氧血症[例（%）]	16（10.0）	22（18.3）	χ² = 4.060^a	0.044
糖皮质激素[例（%）]	116（72.5）	103（85.8）	χ² = 7.154^a	0.007
IVIG [例（%）]	4（2.5）	19（15.8）	χ² = 16.169^a	< 0.001
肺不张[例（%）]	36（22.5）	52（43.3）	χ² = 13.810^a	< 0.001
胸腔积液[例（%）]	38（23.8）	51（42.5）	χ² = 11.118^a	0.001
WBC [M（P25，P75），× 10⁹/L）]	7.5（5.8，11.2）	7.8（6.2，13.4）	Z = 0.526	0.349
N% [M（P25，P75），%]	73.4（68.9，77.5）	78.5（70.2，83.6）	Z = 1.659	< 0.001
PLT [M（P25，P75），× 10⁹/L）]	279.8（232.3，332.6）	245.6（203.5，315.6）	Z = 1.995	< 0.001
CRP [M（P25，P75），mg/L]	19.9（11.2，32.2）	28.9（17.9，42.3）	Z = 15.659	< 0.001
PCT [M（P25，P75），ng/ml]	0.24（0.09，0.51）	0.45（0.29，0.66）	Z = 9.654	< 0.001
IL-6 [M（P25，P75），pg/ml]	30.2（19.8，55.6）	52.6（34.6，75.9）	Z = 23.324	< 0.001
ALT [M（P25，P75），U/L]	13.5（9.8，21.1）	18.9（11.2，25.6）	Z = 3.425	< 0.001
LDH [M（P25，P75），U/L]	356.9（246.5，552.3）	513.2（423.6，623.2）	Z = 123.325	< 0.001
APTT [M（P25，P75），s]	27.6（17.8，32.9）	29.5（20.2，35.6）	Z = 0.859	0.302
纤维蛋白原[M（P25，P75），g/L]	3.6（3.1，4.4）	3.8（3.3，4.6）	Z = 0.785	0.269
D-二聚体[M（P25，P75），mg/L]	0.13（0.08，0.42）	0.34（0.16，0.55）	Z = 5.246	< 0.001
IgE [M（P25，P75），IU/L]	114.5（100.5，149.8）	123.5（102.1，156.9）	Z = 1.096	0.124

影响因素	β值	Wald χ²值	OR值	95%CI	P值
峰值体温	1.325	23.524	2.756	2.003~3.567	< 0.001
肺不张	1.602	56.231	3.526	2.869~4.123	< 0.001
胸腔积液	0.902	15.526	2.032	1.456~2.758	< 0.001
N%	0.769	10.102	1.856	1.235~2.632	<0.001
IL-6	0.597	7.023	1.525	1.124~2.201	< 0.001
LDH	0.456	5.123	1.302	1.052~1.968	< 0.001

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