Atopic constitution associated with severe Mycoplasma pneumoniae pneumonia in children
Photo by Myriam Zilles / Unsplash
Key Takeaway
Note that atopic constitution and elevated serum ferritin or IgE are associated with severe MPP in children.
This retrospective cohort study analyzed 377 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) at Wuhan Children's Hospital. Participants were categorized based on allergen-specific IgE testing, defining atopic constitution as positive results and non-atopic constitution as negative. The study aimed to identify clinical characteristics and immune-inflammatory markers associated with severe MPP in this specific population.
The prevalence of atopic constitution among the 377 children was 74.8% (282 of 377). Among those with atopic constitution, 7.1% (20 of 282 children) progressed to severe MPP. Clinical symptoms were more frequent in the atopic group compared to the non-atopic group, with wheezing occurring in 48.6% versus 25.3% of patients, respectively. Stridor was observed in 34.4% versus 20.0%, and dyspnea in 15.2% versus 4.2% of the respective groups. These differences were statistically significant (P < 0.05).
In atopic children, serum ferritin levels greater than 107.61 ng/mL were identified as an independent risk factor for severe MPP, with an odds ratio of 1.01 (95% CI: 1.01–1.02; P < 0.001). Similarly, serum IgE levels exceeding 1,060 IU/mL were associated with severe MPP, yielding an odds ratio of 3.16 (95% CI: 1.10–9.07; P = 0.032). The predictive performance of serum ferritin for severe MPP in atopic children was assessed with an area under the curve of 0.75 (95% CI: 0.60–0.89). No adverse events were reported during the study period.
Key limitations include the retrospective design, lack of reported follow-up duration, and the single-center setting in Wuhan. Because this is an observational study, causal relationships cannot be established. These findings may inform risk assessment in pediatric MPP cases but require validation in prospective studies before altering clinical practice.
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View Original Abstract ↓
To compare the clinical characteristics and immune-inflammatory markers between Mycoplasma pneumoniae pneumonia children with and without atopic constitution, and to identify independent risk factors for severe MPP within the atopic group.
We retrospectively analyzed the medical records of 377 children diagnosed with MPP at Wuhan Children's Hospital between January 1, 2019, and December 31, 2024, who underwent allergen-specific immunoglobulin E (sIgE) testing for both inhalant and food allergens. The children were divided into two groups based on their atopic constitution: the atopic constitution group (n = 282) and the non-atopic constitution group (n = 95). General data, clinical symptoms, and laboratory test results were compared between the two groups. Logistic regression was used to identify independent risk factors for severe MPP in children with an atopic constitution, and ROC curves were used to determine the cutoff values for predictive markers.
Among the 377 children with MPP, 282 (74.8%) were identified as having an atopic constitution. Within the atopic constitution group (n = 282), 20 children (7.1%) progressed to severe Mycoplasma pneumoniae pneumonia (SMPP). No significant differences were observed between the atopic and non-atopic groups regarding age, fever duration, or length of hospital stay (P > 0.05). However, the atopic group showed a significantly higher incidence of wheezing (48.6% vs. 25.3%), stridor (34.4% vs. 20.0%), and dyspnea (15.2% vs. 4.2%) (P 107.61 ng/mL (OR = 1.01, 95% CI: 1.01–1.02, P 1,060 IU/mL (OR = 3.16, 95% CI: 1.10–9.07, P = 0.032) were independent risk factors for severe MPP in children with atopic constitution. The ROC curve indicated that serum ferritin had the highest predictive performance (AUC = 0.75, 95% CI: 0.60–0.89).
Children with an atopic constitution exhibited a significantly higher prevalence of airway hyperreactivity symptoms during Mycoplasma pneumoniae infection compared to those without an atopic background. Clinically, high serum ferritin and IgE levels should be considered important independent risk factors for predicting severe MPP in children with an atopic constitution, which could facilitate early intervention and improve prognosis.
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