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Risk factors associated with plastic bronchitis in children with severe Mycoplasma pneumoniae pneumonia: a systematic

Yang Zhai1, Yiting Du1, Yanru Liu2

  • 1Emergency Department, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Journal of Thoracic Disease
|May 25, 2026
PubMed

Insights

Elevated lactate dehydrogenase (LDH), prolonged fever, D-dimer, and specific radiological findings significantly increase the risk of plastic bronchitis (PB) in children with severe Mycoplasma pneumoniae pneumonia (MPP). These factors aid in early risk stratification for timely intervention.

Area of Science:

  • Pediatric Pulmonology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Plastic bronchitis (PB) is a severe complication of Mycoplasma pneumoniae pneumonia (MPP) in children, characterized by obstructive bronchial casts.
  • Early identification of risk factors for PB is crucial for timely bronchoscopic intervention and improved outcomes.
  • Existing studies have reported inconsistent findings on risk factors, necessitating a comprehensive meta-analysis.

Purpose of the Study:

  • To systematically evaluate and quantitatively synthesize evidence on risk factors associated with PB in pediatric severe or refractory MPP.
  • To focus on inflammatory biomarkers, radiological features, and clinical characteristics as potential risk factors.

Main Methods:

  • A systematic literature search was conducted across major databases from January 2015 to December 2025.
  • Included were case-control and cohort studies on pediatric patients with severe or refractory MPP and bronchoscopically confirmed PB.
  • Random-effects meta-analysis was performed, with effect sizes expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS).

Main Results:

  • Twelve studies from China, involving 4,406 children (1,123 PB cases), were included.
  • Significant risk factors for PB included elevated lactate dehydrogenase (LDH) (OR=4.06), prolonged fever duration (OR=3.70), elevated D-dimer (OR=2.63), pleural effusion (OR=2.46), atelectasis (OR=2.32), and extensive lung consolidation (OR=1.79).
  • Radiological factors and LDH showed low heterogeneity (I²=0%), while procalcitonin (PCT) and fever duration exhibited substantial heterogeneity.

Conclusions:

  • Elevated LDH, prolonged fever, D-dimer, and specific radiological findings (pleural effusion, atelectasis, consolidation) are significantly associated with increased PB risk in pediatric severe MPP.
  • These identified risk factors can inform early clinical risk stratification and guide decisions for bronchoscopic intervention.
  • Further prospective multicenter studies are needed to develop and validate clinical prediction models incorporating these factors.
Abstract

Keywords:
Mycoplasma pneumoniaebronchial castchildrenmeta-analysisplastic bronchitis (PB)risk factorsrisk stratification

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