Clinical Characteristics and Early Risk Factors for Severe Mycoplasma Pneumoniae Pneumonia in Hospitalized Children: A Retrospective Analysis of 417 Cases

Background: Mycoplasma pneumoniae pneumonia (MPP) represents a common form of community-acquired pneumonia in children, and a proportion of cases progress to severe Mycoplasma pneumoniae pneumonia (SMPP), which may result in serious complications and life-threatening outcomes. Effective indicators for early recognition of severe disease remain unclear. Methods: This retrospective analysis included 417 hospitalized children diagnosed with MPP, comprising 210 children with SMPP and 207 children with general Mycoplasma pneumoniae pneumonia (GMPP), admitted to The Seventh Medical Centre, Chinese PLA General Hospital, from October 2023 to February 2025. Clinical information, laboratory results, and imaging findings obtained within 24 hours of admission were collected. Differences between groups were compared, and logistic regression analysis along with receiver operating characteristic (ROC) curve analysis was performed to identify risk factors and their predictive value. Results: Children with SMPP had longer hospitalization and higher frequencies of extrapulmonary complications. Their C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and D-dimer (DD) levels were markedly higher. Imaging findings more often demonstrated lobar pneumonia, atelectasis, and pleural effusion. Multivariate logistic regression analysis identified CRP, AST, LDH, and DD as independent risk factors for SMPP. ROC analysis indicated that LDH greater than 286.5 U/L, DD greater than 0.1965 mg/L, and AST greater than 25.05 U/L were strong predictors of SMPP. Conclusion: The clinical and laboratory profiles of children with SMPP differed significantly from those with GMPP. CRP, AST, LDH, and DD function as important indicators for early identification and assessment of disease severity, supporting clinical decision making. Early monitoring of these parameters enables timely recognition of high-risk patients and may improve clinical management and prognosis. Keywords: clinical characteristics, inflammatory factors, Mycoplasma pneumoniae pneumonia, predictive indicators, risk factors