Refractory Mycoplasma Pneumonia in Children: A Systematic Review and Meta-analysis of Laboratory Features and Predictors

Background. Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia (CAP) in children. M. pneumoniae infection is usually regarded as a self-limiting disease, but in some special cases, it can also develop into refractory Mycoplasma pneumoniae pneumonia (RMPP). The aim of this study is to analyze the clinical characteristics of CRP (C-reactive protein), LDH (lactate dehydrogenase), ESR (erythrocyte sedimentation rate), D-dimer, neutrophils (%), lymphocytes (%), and lung consolidation in RMPP and explore their prediction results in the early stage of RMPP, which is important for early treatment. Methods. This systematic search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wangfang, and Cqvip, and the date was set until February 23, 2021. For the continuous variables, mean difference (MD) with 95% CI was adopted to evaluate CRP, LDH, ESR, D-dimer, neutrophils (%), lymphocytes (%), and the correlation between lung consolidation and RMPP. Results. 20 studies including 5289 patients were included in the analysis, and the results showed that the CRP of the RMPP group (MD (95% CI): 22.29 (12.20, 32.38), P 0.001 ), LDH (MD (95% CI): 145.13 (78.62, 211.64), P 0.001 ), neutrophils (%) (MD (95% CI): 7.27 (0.31, 14.23), P = 0.04 ), and D-dimer (MD (95% CI): 1.79 (-1.17, 4.74), P = 0.24 ) was higher than that of the NRMPP group; the risk of lung consolidation in the RMPP group (OR (95% CI): 14.29 (4.52, 45.12), P 0.001 ) was higher than that in the NRMPP group, and there was no difference in ESR (MD (95% CI): 8.11 (-1.34, 17.56), P = 0.09 ) and lymphocytes (%) (MD (95% CI): -6.27 (-12.81, 0.27), P = 0.06 ) between the two groups. Conclusion. So, the available evidence indicates that CRP, LDH, neutrophils (%), D-dimer, and lung consolidation are predictive factors for RMPP.