Clinical Role of Serum Interleukin-17A in the Prediction of Refractory Mycoplasma pneumoniae Pneumonia in Children

Figures & data

Figure 1 The study flow chart.

Abbreviations: CAP, community-acquired pneumonia; MPP, Mycoplasma pneumoniae pneumonia; NRMPP, non-refractory Mycoplasma pneumoniae pneumonia; RMPP, refractory Mycoplasma pneumoniae pneumonia.

Table 1 Comparison of Clinical Characteristics Between NRMPP Group and RMPP Group

Clinical Characteristics	NRMPP Group (n=109)	RMPP Group (n=45)	t or χ^2	P-values
Age (years)	8.8 ± 2.8	9.3 ± 2.7	−0.898	0.371
Sex (n)			0.374	0.541
Male	62	28
Female	47	17
Peak body temperature (°C)	39.0 ± 0.9	39.2 ± 0.8	−1.320	0.189
Tachypnea^a (n, %)	18 (16.5%)	15 (33.3%)	5.352	0.021
Cyanosis (n, %)	5 (4.6%)	7 (15.6%)	5.333	0.021
Hypoxia^b (n, %)	10 (9.2%)	10 (22.2%)	4.799	0.028
Duration of hospitalization (days)	9.9 ± 2.2	13.5 ± 2.2	−9.296	0.000
Classification of chest images (n)			43.578	0.000
Bronchial pneumonia	86	10
Segmental/lobar pneumonia	23	35
Pleural effusion (n, %)	8 (7.33%)	17 (37.78%)	15.718	0.000

Notes: ^aTachypnea: infants, respiratory rate >70 breaths/min; older children, respiratory rate >50 breaths/min. ^bHypoxia: oxygen saturation <94%.

Abbreviations: MPP, Mycoplasma pneumoniae pneumonia; RMPP, refractory Mycoplasma pneumoniae pneumonia.

Table 2 Comparison of Laboratory Findings Between NRMPP Group and RMPP Group

Laboratory Findings	NRMPP Group (n=109)	RMPP Group (n=45)	z	P-values
WBC (×10^9/L)	8.5 (7.1–9.6)	8.1(6.9–9.2)	−0.682	0.495
Neutrophils %	61.5 (48.6–66.1)	60.4 (46.7–70.5)	−0.050	0.960
Lymphocyte %	26.4 (20.3–39.1)	25.2 (15.9–36.8)	−0.836	0.403
Hemoglobin (g/L)	122 (118–131)	121 (118–127)	−1.158	0.247
Platelet (×10^9/L)	256 (175.5–302.0)	254 (180.5–357.0)	−0.519	0.604
CRP (mg/L)	12.0 (7.4–16.8)	15.3 (11.1–23.0)	−3.030	0.002
ESR (mm/h)	17.0 (12.0–22.5)	17.0 (14.0–24.0)	−0.978	0.328
Procalcitonin (ng/mL)	0.16 (0.08–0.38)	0.15 (0.08–0.35)	−0.062	0.951
Ferritin (ng/mL)	193.2 (141.3–261.6)	245.4 (180.7–355.4)	−4.779	0.000
LDH (IU/L)	394.0 (321.0–494.5)	571.0 (441.5–664.5)	−5.463	0.000
IL-18 (pg/mL)	416.1 (310.9–596.0)	686.4 (468.4–865.9)	−5.353	0.000
IL-17A (pg/mL)	8.6 (6.4–10.7)	16.3 (10.9–21.3)	−6.266	0.000

Note: All the blood samples were collected and determined within 24 hrs of admission.

Abbreviations: MPP, Mycoplasma pneumoniae pneumonia; RMPP, refractory Mycoplasma pneumoniae pneumonia; WBC, white blood cell; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; LDH, lactate dehydrogenase; IL-18, interleukin-18; IL-17A, interleukin-17A.

Figure 2 Correlation between serum IL-17A and other biomarkers in children with MPP.

Notes: (A) CRP. (B) Ferritin. (C) LDH. (D) IL-18. All the blood samples were collected and determined within 24 hrs of admission.

Abbreviations: IL-17A, interleukin-17A; CRP, C-reactive protein; LDH, lactate dehydrogenase; IL-18, interleukin-18.

Table 3 ROC Curve of Inflammatory Markers in Children with RMPP

Inflammatory Markers	Cutoff Value	AUC	SE	95% CI	Sensitivity	Specificity	P-values
CRP	12.1	0.655	0.048	0.561–0.750	0.733	0.550	0.002
Ferritin	208.2	0.745	0.042	0.663–0.828	0.644	0.752	0.000
LDH	436.5	0.775	0.038	0.700–0.850	0.778	0.624	0.000
IL-18	464.5	0.775	0.039	0.698–0.852	0.822	0.596	0.000
IL-17A	10.8	0.822	0.039	0.746–0.897	0.778	0.771	0.000

Note: All the blood samples were collected and determined within 24 hrs of admission.

Abbreviations: ROC, receiver operating characteristic; MPP, Mycoplasma pneumoniae pneumonia; CRP, C-reactive protein; LDH, lactate dehydrogenase; IL-18, interleukin-18; IL-17A, interleukin-17A; AUC, area under curve; SE, standard error; CI, confidence interval.

Figure 3 ROC curves of CRP, Ferritin, LDH, IL-18, and IL-17A.

Notes: Diagonal segments are produced by ties. All the blood samples were collected and determined within 24 hrs of admission.

Abbreviations: CRP, C-reactive protein; LDH, lactate dehydrogenase; IL-18, interleukin-18; IL-17A, interleukin-17A.