# Role of Serum Inflammatory Biomarkers in Risk Stratification of Hospitalized Children with Macrolide-Non-Responsive Mycoplasma pneumoniae Pneumonia

## TL;DR

High levels of certain blood markers at admission can help identify children with Mycoplasma pneumonia who are less likely to respond to standard antibiotic treatment.

## Contribution

Elevated ferritin and combined inflammatory biomarkers are novel indicators for early risk stratification of macrolide non-responsiveness in Mycoplasma pneumonia.

## Key findings

- CRP, ferritin, and ESR levels were higher in macrolide-non-responsive Mycoplasma pneumonia patients at admission.
- Elevated ferritin was significantly associated with increased risk of macrolide non-responsiveness.
- Combined elevation of multiple inflammatory biomarkers increased the risk of macrolide non-responsiveness.

## Abstract

What are the main findings?
Elevated ferritin levels were significantly associated with the increased risk for MNMP.When serum inflammatory biomarkers were elevated simultaneously at admission, the risk of developing MNMP was higher.

Elevated ferritin levels were significantly associated with the increased risk for MNMP.

When serum inflammatory biomarkers were elevated simultaneously at admission, the risk of developing MNMP was higher.

What are the implications of the main findings?
Identification of hospitalized children with MP who are at risk of macrolide non-responsiveness using inflammatory biomarkers.The combined assessment of serum inflammatory biomarkers is more helpful for MNMP risk stratification.

Identification of hospitalized children with MP who are at risk of macrolide non-responsiveness using inflammatory biomarkers.

The combined assessment of serum inflammatory biomarkers is more helpful for MNMP risk stratification.

Background/Objectives: Macrolide is the first-line treatment in children with Mycoplasma pneumonia; however, macrolide-non-responsive Mycoplasma pneumoniae pneumonia (MNMP) has been increasing recently. We aimed to investigate serum inflammatory biomarkers that could identify children at risk of clinically defined macrolide non-responsiveness as early as possible. Methods: This retrospective cohort study included 93 children hospitalized with Mycoplasma pneumonia between September 2019 and January 2020. Patients were classified into macrolide-sensitive MP (MSMP) and MNMP groups based on clinical response to treatment. Clinically defined MNMP was defined as persistent fever and lack of clinical improvement after at least 3 days of macrolide therapy, reflecting macrolide non-responsiveness in routine clinical practice. By reviewing medical records, we compared laboratory findings at admission, including serum procalcitonin (PCT), C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and erythrocyte sedimentation rate (ESR), between the two groups to identify potential predictive biomarkers. Multivariable logistic regression analysis was used to estimate the risk for MNMP based on serum inflammatory biomarkers. Results: CRP, ferritin, and ESR levels at admission were higher in the MNMP group than the MSMP group. By multivariate analysis, elevated ferritin levels were significantly associated with an increased risk of macrolide non-responsiveness. In addition, when serum inflammatory biomarkers were elevated simultaneously at admission, the risk of MNMP was higher. Conclusions: Serum inflammatory biomarkers may assist in early risk stratification of children with clinically defined macrolide non-responsiveness following macrolide therapy. Furthermore, combined assessment of multiple inflammatory biomarkers may improve early risk evaluation.