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. 2025 Jun 27:13:1512689.
doi: 10.3389/fped.2025.1512689. eCollection 2025.

Risk factors for refractory Mycoplasma pneumoniae in Chinese children: a meta-analysis

Chun Chen  1 , Shan Chen  2 , Chuanzhong Yang  1 , Xiaolan Zhang  2 , Luohui Liu  2 , Yuejuan Wang  2 , Min Cao  2
Affiliations

Risk factors for refractory Mycoplasma pneumoniae in Chinese children: a meta-analysis

Chun Chen et al. Front Pediatr. .

Abstract

Background: With the increase of the incidence rate of Mycoplasma pneumoniae in children and the widespread use of azithromycin, the number of cases of refractory M. pneumoniae increased accordingly. M. pneumoniae infection was generally considered a self-limiting disease. However, under certain special circumstances, it was highly likely to develop into a refractory disease. This study conducted a meta-analysis of early risk factors for refractory Mycoplasma pneumoniae pneumonia (RMPP), which was helpful for the early clinical diagnosis of RMPP and the reduction of sequelae.

Methods: This systematic search was conducted in Web of Science, Embase, PubMed, Cochrane Library, CNKI, Wangfang, Sinomed and Cqvip, and the date was set until August 20, 2024. After two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies, a meta-analysis was conducted using STATA 17.0 and RevMan 5.4 software.

Results: Twenty-eight studies including 6374 patients were included in this analysis, and the results showed that the age [MD (95% CI): 0.62 (0.21, 1.03), P = 0.003], LDH [MD (95% CI): 161.57 (128.22, 194.91), P < 0.001], neutrophils (%) [MD (95% CI): 9.27 (3.45, 15.09), P = 0.002], IL-6 [MD (95% CI): 23.07 (20.90, 25.24), P = 0.04], ESR [MD (95% CI): 10.93 (7.75, 14.11), P < 0.001], AST [MD (95% CI): 16.11 (8.21, 24.01), P < 0.001], ALT [MD (95% CI): 23.69 (9.60, 37.77), P = 0.001], CRP [MD (95% CI): 23.72 (18.41, 29.03), P < 0.001], and WBC [MD (95% CI): 1.07 (0.28, 1.86), P = 0.008] were higher in the RMPP group than in the NRMPP group. Combined pleural effusion (OR = 7.59, 95% CI: 4.19-13.75, P < 0.001) and lung consolidation (OR = 10.61, 95% CI: 4.13-27.26, P < 0.001) were identified as risk factors for RMPP. However, no significant association was found between gender and the incidence of RMPP (OR = 0.91, 95% CI: 0.80-1.02, P = 0.10). The analysis of publication bias indicated that 3 of the 11 factors analyzed [LDH, neutrophils (%), and lung consolidation] showed significant publication bias (P < 0.05).

Conclusion: Our study further confirmed that elevated inflammatory markers such as CRP, LDH, neutrophils (%), IL-6, ESR, lung consolidation, combined pleural effusion were risk factors for RMPP. For the first time, WBC, ALT, and AST were identified as risk factors for the occurrence of RMPP in children. Additionally, demographic information such as age and gender was also examined in relation to RMPP in children.

Keywords: child; children; meta-analysis; refractory mycoplasma pneumoniae; riskfactors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Retrieval flow chart.
Figure 2
Figure 2
(A) Estimated MD summary for age. (B) Funnel plot for publication bias risk of age.
Figure 3
Figure 3
(A) Estimated OR summary for gender. (B) Funnel plot for publication bias risk of gender.
Figure 4
Figure 4
(A) Estimated MD summary for CRP. (B) Funnel plot for publication bias risk of CRP.
Figure 5
Figure 5
(A) Estimated MD summary for LDH. (B) Funnel plot for publication bias risk of LDH.
Figure 6
Figure 6
Estimated MD summary for combination of CRP and LDH levels.
Figure 7
Figure 7
(A) Estimated MD summary for WBC. (B) Funnel plot for publication bias risk of WBC.
Figure 8
Figure 8
Estimated MD summary for neutrophils (%).
Figure 9
Figure 9
Estimated MD summary for fever duration (days).
Figure 10
Figure 10
Estimated MD summary for AST.
Figure 11
Figure 11
Estimated MD summary for ALT.
Figure 12
Figure 12
Estimated MD summary for IL-6.
Figure 13
Figure 13
Estimated MD summary for ESR.
Figure 14
Figure 14
(A) Estimated OR summary for combined pleural effusion. (B) Funnel plot for publication bias risk of combined pleural effusion.
Figure 15
Figure 15
Estimated OR summary for lung consolidation.
See this image and copyright information in PMC

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