Association Between Pre-Admission 48-Hour Fever Burden and Outcomes in Pediatric Mycoplasma Pneumoniae Infection

Area of Science:

• Pediatric Pulmonology
• Infectious Diseases
• Biomarker Discovery

Background:

• Pediatric Mycoplasma pneumoniae pneumonia (MPP) can have severe and refractory courses.
• Current early risk stratification relies on limited admission biomarkers.
• A need exists for improved predictors of in-hospital outcomes in pediatric MPP.

Purpose of the Study:

• To evaluate a 48-hour pre-admission fever burden index (FBI48) for predicting in-hospital outcomes in pediatric MPP.
• To assess if FBI48 improves risk stratification models beyond existing clinical and laboratory predictors.

Main Methods:

• Retrospective cohort study of 648 hospitalized children (≤14 years) with laboratory-confirmed MPP.
• FBI48 calculated as area under the temperature-time curve above 38.0 °C in the 48 hours pre-admission.
• Logistic regression models compared base predictors (clinical/lab) with augmented models including FBI48; performance assessed by AUC, Brier score, and decision curve analysis.

Main Results:

• The composite endpoint (refractory or severe MPP) occurred in 27.2% of patients.
• FBI48 was independently associated with the composite endpoint (aOR 1.45) and severe MPP alone (aOR 1.58).
• Adding FBI48 significantly improved model performance (AUC increased from 0.78 to 0.83, p<0.001) and net benefit.

Conclusions:

• A 48-hour pre-admission fever burden metric (FBI48) provides independent and incremental prognostic value in pediatric MPP.
• FBI48 complements guideline-based predictors for improved admission-time risk stratification.
• External validation and prospective evaluation of FBI48 are recommended.