ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Pulmonology
Development and Validation of a Nomogram for Early Prediction of Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children
Provisionally accepted
- 1Baotou Medical College Graduate School, Baotou, China
- 2Ordos Center Hospital, Ordos, China
- 3Ordos Clinical Medical College of Inner Mongolia Medical University, Ordos, China
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Background: Mycoplasma pneumoniae (MP) is a leading cause of community-acquired pneumonia in children, with a significant increase in incidence following the COVID-19 pandemic. The emergence of macrolide-resistant M. pneumoniae (MRMP) has complicated treatment, leading to the concept of macrolide-unresponsive M. pneumoniae pneumonia (MUMPP), defined as lack of improvement after 72 hours of macrolide therapy. Early identification of MUMPP is critical for timely intervention and improved outcomes. This study aimed to develop and validate a nomogram for early prediction of MUMPP in children. Methods: We conducted a retrospective study involving 278 pediatric patients with MP pneumonia, divided into training (n=188) and validation (n=90) sets. Demographic, clinical, laboratory, and chest CT imaging data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of MUMPP. A nomogram was constructed and validated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results: Six independent predictors were identified: tree-in-bud pattern, neutrophil-value, lymphocyte-value, creatine kinase (CK), platelet-to-lymphocyte ratio (PLR), and male gender. The nomogram demonstrated strong discriminatory power, with area under the curve (AUC) values of 0.838 (95% CI: 0.779–0.897) in the training set and 0.835 (95% CI: 0.752–0.918) in the validation set. Calibration and DCA confirmed good clinical utility. Conclusion: We developed and validated a simple‐to‐use nomogram for predicting MUMPP in early stage. The nomogram demonstrates strong discriminatory power and calibration, and may be a practical tool for clinical practice.
Keywords: Mycoplasma pneumoniae pneumonia, Macrolide-resistant, Children, nomogram, Prediction model, Tree-in-bud sign, Neutrophil, platelet-to-lymphocyte ratio
Received: 31 Aug 2025; Accepted: 05 Nov 2025.
Copyright: © 2025 Liu, Sa, Xin, Zhang and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hai Du, nthaity@126.com
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