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Clinical Prediction of Necrotizing Pneumonia in Children With Mycoplasma pneumoniae: A Model Based on Early Response

Jia Feng Zheng1, Meng Yao Zhang1, Han Quan Dong1

  • 1Department of Pediatric Respiratory Medicine, Children's Hospital, Tianjin University/Tianjin Children's Hospital, Tianjin, China, hardinge.org.

Canadian Respiratory Journal
|August 5, 2026
PubMed
Abstract

Insights

Children with Mycoplasma pneumoniae pneumonia (MPP) unresponsive to treatment are at risk for necrotizing pneumonia (NP). Higher white blood cell count, prolonged fever, pleural effusion, and elevated C-reactive protein predict NP development.

Area of Science:

  • Pediatric infectious diseases
  • Respiratory medicine
  • Clinical diagnostics

Background:

  • Mycoplasma pneumoniae pneumonia (MPP) can lead to severe complications like necrotizing pneumonia (NP).
  • Identifying children with MPP unresponsive to initial therapy who are at high risk for NP is crucial for timely intervention.
  • Predictive factors for NP progression in macrolide-unresponsive MPP (MUMPP) require further elucidation.

Purpose of the Study:

  • To identify predictors of necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) who do not respond to initial treatment.
  • To develop and validate a predictive model for early clinical decision-making in cases of treatment-resistant MPP.

Main Methods:

  • Retrospective analysis of clinical and laboratory data from children with MUMPP.
  • Classification of patients into observation (developed NP) and control (did not develop NP) groups.
  • Multivariable logistic regression for predictor identification, nomogram development, and model validation using ROC analysis and calibration plots.

Main Results:

  • Increased white blood cell (WBC) count, prolonged fever, pleural effusion, and elevated C-reactive protein (CRP) were independently associated with NP.
  • The predictive model demonstrated good discrimination with an AUC of 0.848 in the derivation cohort and 0.889 in the validation cohort.
  • Calibration plots showed close agreement between predicted and observed risks, indicating model reliability.

Conclusions:

  • Higher WBC count, prolonged fever, presence of pleural effusion, and elevated CRP are key indicators of increased NP risk in children with MUMPP.
  • The developed predictive model effectively identifies children at high risk for NP progression.
  • This model can aid clinicians in making informed decisions for managing children with severe MPP.

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