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Factors associated with pulmonary embolism in children with refractory Mycoplasma pneumoniae pneumonia and elevated

Geng Wang1, Luanjie Yao1, Bao Tie2

  • 1Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.

Frontiers in Pediatrics
|July 10, 2026
PubMed

Insights

Pulmonary embolism (PE) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) is linked to higher neutrophil counts, elevated D-dimer, specific antibodies, and left lower lobe consolidation. These factors aid in diagnosing PE in this vulnerable pediatric population.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Hematology

Background:

  • Refractory Mycoplasma pneumoniae pneumonia (RMPP) can lead to serious complications like pulmonary embolism (PE).
  • Diagnosing PE in children with RMPP is challenging due to nonspecific symptoms, often resulting in diagnostic delays.
  • Elevated D-dimer levels are a common finding in children with RMPP and suspected PE.

Purpose of the Study:

  • To identify clinical and laboratory factors associated with pulmonary embolism (PE) in pediatric patients diagnosed with refractory Mycoplasma pneumoniae pneumonia (RMPP) and elevated D-dimer.
  • To improve the early diagnosis of PE in children with RMPP by understanding key predictive indicators.

Main Methods:

  • A cohort study involving 109 children with RMPP and suspected PE from five northern Chinese hospitals.
  • Patients were categorized into PE and non-PE groups based on computed tomographic pulmonary angiography (CTPA) results.
  • Univariate and multivariate logistic regression analyses were used to determine independent predictors of PE.

Main Results:

  • Pulmonary embolism (PE) was diagnosed in 45.0% of the children with refractory Mycoplasma pneumoniae pneumonia (RMPP).
  • Independent factors associated with PE included higher neutrophil counts, elevated D-dimer levels, simultaneous positivity for lupus anticoagulant and antinuclear antibodies, and left lower lobe consolidation.
  • Clinical features did not significantly differ between PE and non-PE groups, highlighting the importance of laboratory and imaging findings.

Conclusions:

  • Higher neutrophil counts, significant D-dimer elevation, dual positivity for lupus anticoagulant and antinuclear antibodies, and left lower lobe consolidation are key independent predictors of PE in children with RMPP.
  • These findings can aid clinicians in suspecting and diagnosing PE earlier in pediatric patients with RMPP and elevated D-dimer, guiding further diagnostic workup with CTPA.
Abstract

Keywords:
autoantibodychildrend-dimerpulmonary embolismrefractory mycoplasma pneumoniae pneumonia

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