Insights into the Therapeutic of Glucocorticoid for Refractory Mycoplasma Pneumoniae Pneumonia in Children

Abstract Objective To observe the efficacy and safety of different doses of glucocorticoid for refractory mycoplasma pneumoniae pneumonia in children, analyze the clinical characteristics in different groups of patients, and explore the factors related to affect illness severity for children with refractory mycoplasma pneumoniae pneumonia and guide the dosage of glucocorticoids.Methods Retrospective analysis was performed on 279 children with refractory mycoplasma pneumoniae pneumonia hospitalized in our hospital between September 2018 and October 2019. 23 children were excluded, the remaining 256 children were divided into three subgroups: Group I was not given methylprednisolone (n=75), group II (n=115) was given methylprednisolone ≤125mg/d, and group III was given methylprednisolone >125mg/d (n=66). The clinical features, laboratory data, radiological manifestations between three subgroups of children were compared, relevant indicators with meaningful were used for ROC curve and multiple logistic regression analysis, and the optimal values of related factors were analyzed.Results The median age and median weight of the group III were greater than the group II（P <0.05）, the median age and median weight of the group I were greater than the group II（P <0.05）, there was no statistical significance in median age and median weight between group III and group I（P>0.05）. The group II is more serious than that of group I, and group III is more serious than that of group II, higher incidence of hypoxemia, longer fever, longer hospital stays, higher incidence of extrapulmonary complications, and more severe of radiological findings (P <0.05). The more severe presentation of disease, hormones dosage was larger, the use rate of gamma globulin was higher, the use rate of bronchoscopy was higher, and higher incidence of plastic bronchitis (P <0.05). Meanwhile, WBC, CRP, LDH, FER, D-D dimer, APTT, PLT, PCT, IL-6, ALT and the percentage of neutrophils in the three groups showed a gradual upward trend (P <0.05). In ROC curve analysis, WBC, neutrophils percentage, CRP, LDH, Fer, PCT and IL-6 can be used to distinguish RMPP with different severity and to guide the dosage of glucocorticoids. Multivariate logistic regression analysis showed that LDH 424.5IU/L, PCT 0.145ng/ml, IL-6 26.69pg/ml and lung consolidation were significant predictors for the severity of RMPP and glucocorticoids dose.Conclusions LDH 424.5IU/L, PCT 0.145 ng/ml, IL-6 26.69pg/ml and pulmonary consolidation as markers of disease severity in patients with RMPP and the dosage of glucocorticoids, which can aid in early recognition of children with severe illness, use appropriate doses of hormones, and reduce sequelae.