Konstrukcija modela za rano predviđanje egzacerbacije pneumonije izazvane Mycoplasmom pneumoniae kod dece: studija inkrementalne vrednosti zasnovana na dinamičkim promenama C-reaktivnog proteina i potklasa IgG
Sažetak
Uvod/Cilj. Egzacerbacija (pogoršanje) pneumonije izazvane Mycoplasmom pneumoniae (Mycoplasma pneumoniae pneumonija – MPP) kod dece obično se manifestuje kao teška ili refraktorna bolest. Cilj rada bio je da se proceni prediktivna vrednost dinamičke procentualne promene C-reaktivnog proteina – CRP (ΔCRP%) i potklase imunoglobulina (Ig) G1 za pogoršanje MPP kod dece kao i da se utvrdi da li njihovo uključivanje u osnovni prediktivni model poboljšava predviđanje pogoršanja bolesti. Metode. Ovom retrospektivnom studijom obuhvaćeni su pedijatrijski bolesnici sa dijagnozom MPP u periodu između 2020. i 2023. godine, koji su uključeni u studiju i svrstani u grupe prema pojavi pogoršanja MPP. Prikupljeni su početni klinički podaci, laboratorijski parametri, rezultati serijskih merenja CRP-a (u 0. i 72. satu), kao i nivoi potklasa IgG1–IgG4. Prema predviđenim verovatnoćama koje je generisao unapređeni model, bolesnici su podeljeni u tri grupe rizika: nizak rizik (< 0,20), srednji rizik (0,20–0,35) i visok rizik (≥ 0,35). Rezultati. Od 512 pedijatrijskih bolesnika, kod njih 110 (21,5%) zabeleženo je pogoršanje MPP. Multivarijantnom analizom kao nezavisni prediktori identifikovani su trajanje groznice, obostrana zahvaćenost pluća, snižen procenat limfocita, povišena laktat dehidrogenaza, povišen D-dimer, viši ΔCRP% (po povećanju od 10 procentnih poena) i niski nivoi IgG1 (p < 0,05). Unapređeni model je pokazao bolju diskriminativnu sposobnost, sa vrednošću površine ispod receiver operating characteristic (ROC) krive (area under the curve – AUC) od 0,873, što je značajno više nego kod osnovnog modela (0,792; p = 0,004). Analizom stratifikacije rizika pokazano je progresivno povećanje stope primećenih egzacerbacija u grupama niskog, srednjeg i visokog rizika (približno 10%, 30% i 50%, redom). Zaključak. I ΔCRP% i niski nivoi IgG1 nezavisni su prediktori egzacerbacije MPP kod dece. Uključivanje tih markera značajno poboljšava diskriminativnu sposobnost, kalibraciju i kliničku korisnost modela za predviđanje rizika od progresije bolesti.
Reference
Biagi C, Cavallo A, Rocca A, Pierantoni L, Antonazzo D, Dondi A, et al. Pulmonary and extrapulmonary manifestations in hospi-talized children with Mycoplasma pneumoniae infection. Mi-croorganisms 2021; 9(12): 2553. DOI: 10.3390/microorganisms9122553.
Zhang X, Sun R, Jia W, Li P, Song C. A new dynamic nomo-gram for predicting the risk of severe Mycoplasma pneumoni-ae pneumonia in children. Sci Rep 2024; 14(1): 8260. DOI: 10.1038/s41598-024-58784-3.
Jia R, Guo H, Lu A, Zhang C, Qi Y, Wang D, et al. Immuno-logical landscape of children with Mycoplasma pneumoniae pneumonia in the post-COVID-19 era reveals distinctive se-verity indicators. Respir Res 2025; 26(1): 103. DOI: 10.1186/s12931-025-03189-7.
Kant R, Kumar N, Malik YS, Everett D, Saluja D, Launey T, et al. Critical insights from recent outbreaks of Mycoplasma pneumoniae: decoding the challenges and effective interven-tions strategies. Int J Infect Dis 2024; 147: 107200. DOI: 10.1016/j.ijid.2024.107200.
Chen X, Wang S, Cai H, Xia X. The predictive values of C-reactive protein-neutrophil to lymphocyte ratio for the risk of refractory Mycoplasma pneumoniae pneumonia in children: a retrospective cohort study. Epidemiol Infect 2024; 152: e158. DOI: 10.1017/S0950268824001134.
Li L, Zhang Y, Zhao L, Shi Y. C-reactive protein-induced inju-ry in Mycoplasma pneumoniae-infected lung epithelial cells is mediated by the P38 MAPK/mitochondrial apoptosis path-way. Microbiol Spectr 2025; 13(3): e0162624. DOI: 10.1128/spectrum.01626-24.
Li X, Wang Y, Wang Q, Wu H, Yan Y, Xiong Y, et al. Immune dysregulation in Mycoplasma pneumoniae pneumonia: mecha-nistic controversies and clinical translation from inflammatory dysregulation and immune evasion to chronic injury. Front Immunol 2026; 17:1724496. DOI: 10.3389/fimmu.2026.1724496.
Li D, Zheng H, Wang X, Li F, Wang H, Chen H, et al. Investi-gation of T lymphocyte subsets in children with Mycoplasma pneumoniae pneumonia. Immunol Res 2025; 73(1): 24. DOI: 10.1007/s12026-024-09576-4.
Tuo W, Guo X, Wu M, Xie S, Shen X, Wang J, et al. Applica-tion value of antibody titres and RNA detection in the early prediction of Mycoplasma pneumoniae pneumonia in children: a retrospective study. BMC Infect Dis 2023; 23(1): 220. DOI: 10.1186/s12879-023-08161-8.
Gong W, Gao K, Shan Z, Yang L, Fang P, Li C, et al. Research progress of biomarkers in evaluating the severity and prognos-tic value of severe pneumonia in children. Front Pediatr 2024; 12: 1417644. DOI: 10.3389/fped.2024.1417644.
Zhang YX, Li Y, Wang Y, Ren YF, Yang Y, Qi J, et al. Prospec-tive cohort study on the clinical significance of interferon-γ, D-dimer, LDH, and CRP tests in children with severe myco-plasma pneumonia. Medicine (Baltimore) 2024; 103(41): e39665. DOI: 10.1097/MD.0000000000039665.
Reccardini N, Confalonieri M, Ruaro B, Confalonieri P, Da Re B, Rocca A, et al. Early C-reactive protein reduction predicts sur-vival in COVID-19 severe pneumonia treated with glucocor-ticoids. BMC Pulm Med 2025; 25(1): 436. DOI: 10.1186/s12890-025-03874-9.
Dogru D, Dogru Y, Atschekzei F, Elsayed A, Dubrowinskaja N, Ernst D, et al. Reappraisal of IgG subclass deficiencies: a ret-rospective comparative cohort study. Front Immunol 2025; 16: 1552513. DOI: 10.3389/fimmu.2025.1552513.
Lee H, Kovacs C, Mattman A, Hollander Z, Chen V, Ng R, et al. The impact of IgG subclass deficiency on the risk of mortality in hospitalized patients with COPD. Respir Res 2022; 23(1): 141. DOI: 10.1186/s12931-022-02052-3.
Barton JC, Barton JC, Bertoli LF, Acton RT. Factors associated with IgG levels in adults with IgG subclass deficiency. BMC Immunol 2021; 22(1): 53. DOI: 10.1186/s12865-021-00447-3.
Wang S, Jiang Z, Li X, Sun C, Zhang Y, Xiao Z. Diagnostic val-ue of serum LDH in children with refractory Mycoplasma pneumoniae pneumoniae: A systematic review and meta-analysis. Front Pediatr 2023; 11: 1094118. DOI: 10.3389/fped.2023.1094118.
Jiang C, Bao S, Shen W, Wang C. Predictive value of immune-related parameters in severe Mycoplasma pneumoniae pneu-monia in children. Transl Pediatr 2024; 13(9): 1521–8. DOI: 10.21037/tp-24-172.
Guo H. Prognostic value of serum CRP, IgM and IgA levels in children with Mycoplasma pneumoniae and pleural effusion. J Med Biochem 2025; 44(6): 1279–87. DOI: 10.5937/jomb0-54947.
Fan F, Lv J, Yang Q, Jiang F. Clinical characteristics and serum inflammatory markers of community-acquired mycoplasma pneumonia in children. Clin Respir J 2023; 17(7): 607–17. DOI: 10.1111/crj.13620.